Compact Communications

Madeleine Kannegiesser-Bailey, Jong Eun Song, Elise Randle and Marissa Willock

Great Ormond Street Hospital for Children

Context A healthcare career is challenging, rewarding and at the forefront of innovation. These are things young people look for when choosing a career path. Among significant workforce shortages, it is important we attract the next generation of healthcare workers who are inspired, diverse and caring for patients.¹

Methods Great Ormond Street Hospital for Children (GOSH) quarterly offers placements on our Young Visitor Programme (YV) where 16–19-year-olds interested in a healthcare career join teams (medical, nursing and allied health) for 1–5 days as observers. Our selection process promotes equitable inclusion to ensure diversity.

Results Between February and October 2023, 191 YVs attended work experience at GOSH. One hundred forty-nine (78%) identified as ethnically diverse, 164 (86%) female and 26 (14%) male. We sent post placement evaluations and received 67 (35%) free-text responses. Most common responses described the enjoyment of ‘life as a doctor’, patient interaction and learning. Participants were overwhelmingly positive, 60/67 (89%) reported still being interested in a healthcare career, and 64/67 (95%) would recommend the programme.

Discussion Our programme has participants from diverse backgrounds and contributes to the NHS aims of widening participation. Early workplace experience provides realistic experiences that encourage young people to pursue healthcare professions. One area for improvement is to increase male applicant application and acceptance rates. Further review to identify limiting factors would be beneficial.

Conclusion The YVP allows young people considering a career in healthcare from diverse background to have real world experience. Our programme demonstrates high levels of positive experience and retention of career aims.

Keywords: EDI; education; healthcare careers; placements; young persons

Reference

1. Jabbal J. Young people are the future: how can recruiters encourage more of them to join the NHS workforce?. Published 14 February 2022. Accessed 20 Jan 2024. http://www.kingsfund.org.uk/blog/2022/02/young-people-how-can-recruiters-encourage-more-join-nhs

Samantha Robinson¹, Janesh Wijeratne² and Rowena McCash²

¹NHS England Workforce Training and Education & Newcastle University; ²NHS England Workforce Training and Education

Background Our faculty provides primary care-based online education sessions for trainee advanced clinical practitioners (tACPs) and physician associate preceptees (PAps). This has worked well for our geographically diverse learners; however, it limits the ability to teach clinical and communication skills. We therefore delivered an in-person teaching day focused on improving these skills in our cohort.

Method Anonymised feedback was collected via an online survey using a Likert scale and free text. Sixty-three learners attended the event, with 51 completing the survey.

Thematic analysis was undertaken using Braun and Clarke's¹ six-phase framework in order to identify the most valuable aspects of the day for the learners.

Conclusion As expected learners found the clinical skills beneficial as per the most common recurring theme of ‘usefulness in practice’.

Speaker qualities of ‘honesty’, ‘openness’ and ‘bravery’ were repeatedly mentioned in feedback. Attendees valued these qualities in the speakers and were inspired to emulate them.

Peer interaction emerged as a key theme exemplifying the importance of ‘belonging’.²

Three out of the four themes documented were not expected prior to our analysis. This shows how important it is to consider hidden outcomes or curricula when teaching and how we interact with colleagues, peers and learners can have immense impact.³ It has also magnified the significance of peer interaction and belonging in an age of online learning.

Keywords: advanced clinical practitioners; clinical skills; peer support; physician associates; primary care

References

1. Braun, V. & Clarke, V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): pp.77–101.

2. Allen, K.A., Kern M.L., Rozek C.S., McInerney D.M., Slavich G.M. Belonging: a review of conceptual issues, an integrative framework, and directions for future research. Aust J Psychol 2021; 73(1): pp.87–102.

3. Bergenhenegouwen, G. Hidden curriculum in the university. High Educ 1987; 16(5): pp.535–543.

Steven Moore¹ and Natasha Wiggins²

¹North Bristol Academy, North Bristol NHS Trust; ²Great Western Hospital NHS Foundation Trust

Background With an ageing population and considerable service gaps of specialist palliative care in the United Kingdom, ambulance services are increasingly managing patients with palliative care needs.^1,2 Their involvement is often unplanned and, with limited information, must make challenging, time-critical decisions.² Lack of education of ambulance staff is a barrier to delivering high-quality care.² Exemplifying this, our regional ambulance service had no palliative care educational programme. Therefore, through one aspect of a multifaceted educational programme, we aimed to improve trainee specialist paramedics' ability in employing palliative care skills and knowledge in practice.

Methods Two 1-day cross-disciplinary sessions were delivered by palliative medicine specialists to groups of 20 trainee specialist paramedics, integrated into their mandatory training. Participants must have completed a palliative and end-of-life care programme before enrolling in the course. Topics covered included legal aspects, palliative emergencies, recognising dying, communication skills and symptom control. Pre- and post-session questionnaires, utilising Likert scale type to assess subject confidence, alongside open questions, were collected. An iterative approach allowed evaluation from the first day to improve the second.

Results Both sessions demonstrated significantly improved confidence in all assessed domains (p = <0.05). Learners particularly valued the sessions' delivery by specialists, their interactivity and the consolidation and application of learning through case discussions.

Discussion This intervention has mitigated a recognised national obstacle to delivering high-quality palliative care by ambulance services. Cross-disciplinary interaction was particularly appreciated, and our hope is that integrating this intervention into an established mandatory training programme will maximise sustainability and foster interprofessional relationships in the future.

Keywords: education; interdisciplinary; palliative; paramedic

References

1. Dixon J, King D, Matosevic T, Clark M, Knapp M. Equity in the provision of palliative care in the UK: review of evidence. London School of Economics and Political Science, Personal Social Services Research Unit, London, UK; 2015.

2. National Health Service. The route to success in end of life care – achieving quality in ambulance services. The National End of Life Care Programme, Leicester, UK; 2012.

Claudia Kate Au-Yeung

NHS, medicSLT_CKAY

Background Speech and language therapists (SLTs) play a vital role in evaluating and advocating for patients with dysphagia, engaging in feed-at-risk (FAR) discussions with the multidisciplinary team (MDT). Decisions regarding FAR can be challenging for fledging therapists, often conflicting with established principles aimed at identifying the safest consistency and minimising aspiration risk (Atkinson, 2022). Here, we introduce a novel mnemonic as a framework to promote holistic FAR management for patients with dysphagia and their families.

Methods Literature review and FAR guidelines informed the creation of the ‘ABCDEFG of risk feeding’ mnemonic. This include alternative feeding, benefits versus risks, capacity, FEEDing adaptations and strategies and goals (short and long term). The mnemonic was introduced in a national workshop, featuring simulated case scenarios for SLTs online.

Results Sixteen participants (47% working SLTs; 53% student SLTs) attended across the United Kingdom. One hundred per cent strongly agreed or agreed that the mnemonic met learning objectives. Eighty-one per cent strongly agreed (n = 6) or agreed (n = 7) that they increased confidence and perceived ability to manage FAR post-session. Additional objectives included, increased knowledge of relevant guidelines (n = 10) and explored a new approach to manage patients' swallowing (n = 10). Free-text feedback highlighted the mnemonic as a valuable structure, for example, ‘great way to remember you have considered every aspect’ and ‘a really good structure to apply to real-life scenarios’.

Conclusion The ‘ABCDEFG risk feeding’ is a novel and effective tool for SLTs to adopt a holistic FAR approach. Future directions involve extending its use to MDT and incorporating it into dysphagia training.

Keywords: dysphagia; education; innovation; speech therapy

Reference

1. Atkinson, K. Shared decision making in dysphagia. Br J Nurs 2020; 31(13): S21–24.

Ivon Kandiah and Louise Younie

Queen Mary University of London

*Please note that this is an undergraduate intercalating medical student's project for a BSc in Medical Education. Data collection is beginning in January 2024, but the study will be completed by May; ethical approval has been obtained.

Background Managing uncertainty has been stated as one of the three core aims of the Medical Licensing Assessment (MLA). At the same time, the Royal College of General Practitioners (RCGP) state that uncertainty is present in clinical decision making and dealing with uncertainty is key to provide person-centred care. However, the word ‘uncertainty’ only appears once in the entire MLA content map, and how to deal with it has only been addressed by using three questions as a prompt for reflection in the RCGP Learning in General Practice handbook. The presence of uncertainty in the medical environment is not a new revelation, yet its absence in medical curricula is conspicuous.¹ There is a need to clearly outline how we manage uncertainty in the pre-medical, pre-clinical and clinical experiences as physicians.² Even though multiple studies have shown that creative enquiry can help better tolerate uncertainty, the question of how creative enquiry may do this has not been answered.³ Developing the pedagogy of creative enquiry through this research will usefully contribute to the education of future clinicians.

Method Twelve semi-structured interviews: six medical students and six general practitioners. Thematic analysis of the transcripts will be carried out using NVivo software.

Result Data collection is ongoing; updates will be provided to support the application.

Keywords: creative enquiry; general practitioner; student; uncertainty

References

1. Luther, V.P. and Crandall, S.J. (2011) ‘Commentary: ambiguity and uncertainty: neglected elements of medical education curricula?’, Acad Med, 86(7), pp. 799–800. https://doi.org/10.1097/acm.0b013e31821da915.

2. Gheihman, G., Johnson, M. and Simpkin, A.L. (2019) ‘Twelve tips for thriving in the face of clinical uncertainty’, Med Teach, 42(5), pp. 493–499. https://doi.org/10.1080/0142159x.2019.1579308.

3. Patel, P., Hancock J., Rogers M., Pollard S.R. (2022) ‘Improving uncertainty tolerance in medical students: a scoping review’, Med Educ, 56(12), pp. 1163–1173. https://doi.org/10.1111/medu.14873.

Loralie Rodrigues, Olanrewaju Sorinola, Rebecca Mole and Collette Clay

Warwick Medical School

Background A meta-analysis of 24000 medical students in 2011 concluded that academic performance due to ethnic differences has existed in medical schools for the last 30 years across all medical schools and exam types^1–3 and the educational and psychological impacts of assessment failure are wide ranging. Bearing in mind that awarding gaps have existed for decades, there is a paucity of research that considers the perspectives of medical students. There are no existing data on the pass/fail awarding gap at Warwick Medical School.

Methods Assessment performance data was analysed for all cohorts of medical students at Warwick Medical School from 2016 to 2021, across all year groups and assessment formats, with the granularity of Asian/Black/Chinese/Mixed race/Other/Preferred not to say/White based on student self-reporting at admission stage.

Results White students are the highest performing ethnic group in 50% first sit of examinations but are the lowest performing ethnic group in 83.3% of second sit of examinations across all year groups and exam formats. Asian students are awarded the least well of all ethnic groups.

Discussion The reasons behind exam failure for ethnic minority students at first sit and their improvement at second sits will be investigated using action research and focus groups to capture the experiences of students who failed exams at the first sit and proceeded to pass the resit, with the intention of offering enhanced exam support to students preparing for second sit exams with the aim of closing the pass/fail and pass/honours awarding gaps.

Keywords: assessment; awarding; education; gap; medical

References

1. Woolf K, Potts HW, McManus IC. Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta- analysis. BMJ. 2011;342:d901. https://doi.org/10.1136/bmj.d901

2. Shah R, Ahluwalia S. The challenges of understanding differential attainment in postgraduate medical education. Br J Gen Pract. 2019;69(686):426–427. https://doi.org/10.3399/bjgp19X705161

3. Fyfe M, Horsburgh J, Blitz J, Chiavaroli N, Kumar S, Cleland J. The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools. Perspect Med Educ 2022;11(1):1–14. https://doi.org/10.1007/s40037-021-00696-3

Russell D'Souza

Chair, International Department of Education, UNESCO Chair in Bioethics, Melbourne, Australia

Background Traditional assessment methods in educational settings primarily involve evaluations by educators, which may not fully engage students in the learning process.¹ Peer assessment, a student-centred approach that aligns with constructivist theories, is gaining recognition for knowledge construction and enhancing critical thinking skills.²

Methods This pilot study employs a mixed-methods approach to explore the efficacy of peer assessments in medical education. Twenty students, each from first to fourth professional years, were involved and divided into two groups: assessor and assessee. Students interchanged their roles after 2 weeks. The study was conducted in three phases for 6 weeks: development of clear rubrics for scoring and training sessions for students on giving constructive feedback (week 1), peer and educator assessments (weeks 2–5) and analysis of feedback from students (week 6). Each student assessed 10 formative assessments and 10 clinical case presentations of their peers in a blinded manner. The same was assessed by educators. The study is currently in phase 2.

Following this, a comparative analysis will be performed with the assessment reports of educators and students. Further, surveys and in-depth small group interviews are planned to focus on their learning experiences, confidence levels and perceptions of the peer assessment process as an assessor and assessee.

Results The study is anticipated to demonstrate improved learning experiences among students. Additionally, students are expected to enhance their skills in providing constructive feedback with higher confidence. A comparison with educator assessments may reveal a significant alignment, suggesting the reliability and effectiveness of peer evaluations in the educational process.

Keywords: assessment; collaborative learning; curricula; medical education; peer learning

References

1. DuCoin C, Zuercher H, McChesney SL, Korndorffer JR. Peer assessment in medical student education: a study of feasibility, benefit, and worth. Am Surg 2022;88(9):2361–2367. https://doi.org/10.1177/00031348211011096

2. Li H, Xiong Y, Hunter CV, Guo X, Tywoniw R. Does peer assessment promote student learning? A meta-analysis. Assess Eval High Educ 2020;45(2):193–211.

Anda Bularga¹, Kirsty Crowe¹, Marilena Giannoudi¹, Hannah Preston¹, Kat Ralston¹, Emma Spencer², Natasha Armstrong² and Christopher Graham²

¹Trainees and Members' Committee (T&MC), Royal College of Physicians of Edinburgh (RCPE); ²Education, Training & Assessment Department, RCPE

Background MRCP (UK) Practical Assessment of Clinical Examination Skills (PACES) is a postgraduate clinical skills examination delivered internationally, required for progression to higher specialist medical training in the UK.¹ An updated PACES format was recently introduced.¹ To support candidates, RCPE's Trainees and Members' Committee (T&MC) developed the ‘Demystifying PACES’ series as part of their established, free ‘Career Conversations’ podcast, which supports medical students and trainees with career guidance and professional development.

Methods Episodes were designed and hosted by T&MC members who have passed PACES, developed in liaison with the wider T&MC (including prospective PACES candidates), RCPE staff and experienced PACES examiners. Episodes aim to ‘demystify’ PACES by exploring how the exam is organised, discussing each station in depth with experienced examiners and gaining perspectives from candidates who recently sat the exam. Production aligns with medical education podcast guidance.² Usage statistics are collected monthly from major podcast platforms (SoundCloud/Apple/Spotify/Google).

Results As of 03/01/2024, four episodes have been released (one in August 2023; three in December 2023) with 504 plays across major platforms. For SoundCloud, one-third (145/427 = 34%) of listeners are non-UK-based, consistent with literature demonstrating international appeal of medical education podcasts.³ Spotify age-based data are consistent with expected candidate ages (60/72 = 83% aged 23–34 years).

Conclusion Early data demonstrate positive engagement with ‘Demystifying PACES’, which takes a novel approach with a range of experienced examiners sharing their expertise. Six episodes will be released in early 2024 with substantial publicity planned. Listener feedback and usage data will inform future development.

Keywords: assessment; education; medical; podcast; postgraduate

References

1. MRCP (UK). Accessed 25 Jan 2024. https://www.mrcpuk.org/mrcpuk-examinations/paces

2. Berk J, Watto M, Williams P. Twelve tips for creating a medical education podcast. Med Teach. 2020;42(11):1221–1227. https://doi.org/10.1080/0142159X.2020.1779205

3. Kelly JM, Perseghin A, Dow AW, Trivedi SP, Rodman A, Berk J. Learning through listening: a scoping review of podcast use in medical education. Acad Med 2022;97(7):1079–1085. https://doi.org/10.1097/ACM.0000000000004565

Amber Knapp-Wilson¹, Kathryn Fleming² and Sarah Allsop¹

¹Bristol Medical School, University of Bristol; ²School of Cellular and Molecular Medicine, University of Bristol

Interpreting blood tests is a fundamental aspect of clinical medicine, offering insight into physiological processes and pathologies and guiding clinical decision making with a reported 60%–70% of medical decisions being based on laboratory results.¹ However, there is a disconnect between healthcare programme curriculums and the clinical application required in practice.² To address this, a resource was developed to provide comprehensive information on blood tests, linking clinical information, underpinning biochemistry and contextual test interpretation.

A review of existing literature was conducted to identify gaps in current educational materials and used to develop the educational resource, including trialling different formats (paper, online, app). Content was curated to find a balance between depth and breadth of content while retaining a user-friendly interface. The resource was tested by healthcare students and professionals (n = 5).

Literature evidence³ and user feedback showed a preference for an online resource. Key information developed included practical clinical aspects of blood testing including information on blood bottles, underlying biochemistry and clinical significance of technical and statistical parameters.

Bloods 101 aims to provide a novel tool that distils the extensive information available on blood testing into a high-yield, practical resource. It aims to equip healthcare students and professionals to explain the ‘why’ of blood tests: why they are carried out in relation to our physiology and why certain pathological processes lead to results. This resource has the potential to enhance patient care by equipping healthcare professionals with knowledge of effective blood test ordering and interpretation, contributing to more accurate diagnoses and treatment decisions.

Keywords: biochemistry; blood tests; online resource; pathology

References

1. Molinaro RJ, Winkler AM, Kraft CS, Fantz CR, Stowell SR, Ritchie JC, Koch DD, Heron S, Liebzeit J, Santen SA, Guarner J. Teaching laboratory medicine to medical students: implementation and evaluation. Arch Pathol Lab Med. 2012;136(11):1423–1429. https://doi.org/10.5858/arpa.2011-0537-EP. PMID: 23106588; PMCID: PMC3767850.

2. Barai I, Gadhvi K, Nair P, Prasad S. The importance of laboratory medicine in the medical student curriculum. Med Educ Online. 2015;20:30309. https://doi.org/10.3402/meo.v20.30309. PMID: 26690575; PMCID: PMC4685301.

3. Delungahawatta, T., Dunne, S.S., Hyde, S., Halpenny L., McGrath D., O'Regan A., Dunne C.P. Advances in e-learning in undergraduate clinical medicine: a systematic review. BMC Med Educ 22, 711 (2022). https://doi.org/10.1186/s12909-022-03773-1

Andrew O'Malley¹, Jon Dowell², Andrew MacFarlane¹ and Shalini Gupta²

¹University of St Andrews; ²University of Dundee

The Scottish Graduate Entry Medical Programme (ScotGEM)¹ is pioneering an approach to medical education aimed at addressing the critical shortage of healthcare professionals in remote and rural regions. This work provides an update on ScotGEM, underscoring its objectives, initial outcomes and the perceived impact by its stakeholders, since its launch in 2018. Central to ScotGEM's mission is the training of doctors with an interest in generalism and remote/rural practice, areas traditionally challenged by recruitment difficulties, thus leaving populations underserved.

Our initial findings² reveal promising trends in our students' career intentions. A significant proportion of ScotGEM graduates express a desire to serve in remote or rural settings, indicative of the programme's alignment with its core mission.

Furthermore, the composition and engagement of our teaching faculty have not only enhanced the educational experience but also contributed to a net influx of medical professionals into our healthcare system. This is particularly noteworthy in the context of traditionally underserved areas.

Student feedback forms a crucial component of our evaluation. General perceptions of the programme have been positive, with students valuing the focus on areas often overlooked in conventional medical training. This feedback is instrumental in continually refining ScotGEM to better serve the needs of remote and rural healthcare.

ScotGEM represents a significant contribution towards sustainable healthcare in remote regions. By aligning educational objectives with regional healthcare needs, the programme not only prepares a new generation of doctors for the unique challenges of rural medicine but also contributes positively to remote and rural communities.

Keywords: careers; generalist; remote; rural; undergraduate

References

1. Scottish Graduate Entry Medicine (ScotGEM) MBChB. Updated January 15, 2024. Accessed 23 Jan 2024. https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/

2. MacFarlane AD, Gupta S, Dowell J, O'Malley A. A qualitative perspective on what factors influence ScotGEM students' career intentions. Rural Remote Health. 2023;23(1):8152. https://doi.org/10.22605/RRH8152

Kristen Davies

Newcastle University

Background Postgraduate medical training in the United Kingdom places a premium on doctors making early career choices. Foundation doctors must make multiple decisions within the first 18 months of work including (1) whether to apply for specialty training, (2) what specialty to apply for and (3) whether to take a post-foundation training break. These all have repercussions for workforce planning. Recent evidence suggests that medical students are considering taking a post-foundation training break, or indeed moving abroad to practise medicine, before even working in the NHS.¹ Given the early timing of these important career decisions, their time at medical school is likely to influence their career planning.

Methods To explore what information has been published regarding medical students and their planning for their early career decisions. A scoping review will be performed adhering to the Arksey and O'Malley guidelines.²

Databases to be searched include MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, ERIC, ASSIA, Scopus and Web of Science.

Results The results of the scoping review will be available at the time of presentation. This review aims to present the information that has already been published about medical students, career planning, specialty choice and the decision to take a post-foundation training break. The results will aim to summarise what is known about medical student engagement in career planning in the United Kingdom to provide further information that can better inform workforce planning and improvements in medical education and both an undergraduate and a postgraduate level.

Keywords: career; decision; medical; planning; student

References

1. Ferreira T, Collins AM, Feng O, The AIMS Collaborative, et al., Career intentions of medical students in the UK: a national, cross-sectional study (AIMS study) BMJ Open 2023;13:e075598. https://doi.org/10.1136/bmjopen-2023-075598

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

Lily Lamb, Hugh Alberti, Gillian Vance and Bryan Burford

Newcastle University

Background Role modelling plays a vital part in the training of future doctors, particularly in supporting them towards careers in general practice.¹ UK general practice faces an ongoing workforce crisis, which is particularly pronounced in areas of high socio-economic deprivation, with resultant impact on patient care.² Medical student numbers are likely to significantly increase in the near future, yet many general practitioners (GPs) who potentially act as role models are burnt out³ and wish to leave the profession, which may limit their ability to influence future doctors positively.

Methods This realist review seeks to unveil key contexts, mechanisms and outcomes, generating a programme theory that seeks to explain how, why and for whom the phenomenon of role modelling can be employed to support medical students towards careers in general practice.

Results This compact communications presentation will describe the initial programme theory (IPT) that has been informed by literature, stakeholder and patient involvement. The IPT suggests that important contexts for exploration in the review include role modelling in ‘deep end’ practices, cultural differences in role modelling, burnout in role models and curriculum influences. Initial findings from the systematic search of key databases including MEDLINE, EMBASE, CINAHL, PsycINFO and grey literature will be presented.

Conclusions The potential of role modelling can be maximised through understanding the barriers and facilitators to positive outcomes. Our programme theory will provide causal explanations and recommendations to support the intended outcomes and reduce unintended outcomes of role modelling in general practice undergraduate education.

Keywords: careers; education; general practice; recruitment; undergraduate

References

1. Royal College of General Practitioners, Medical Schools Council. Destination GP: medical students' experiences and perceptions of general practice. 2017. https://www.rcgp.org.uk/training-exams/discover-general-practice/medical-students/shaping-general-practice.aspx

2. The Health Foundation. Level or not? Comparing general practice in areas of high and low socioeconomic deprivation in England. 2020. https://www.health.org.uk/publications/reports/level-or-not

3. General Medical Council. The state of medical education and practice in the UK. 2021.

Heidi Stelling¹, Megan Brown¹, Bryan Burford¹ and Paul Blaylock²

¹Newcastle University; ²NHS England–Education North East

Background Concerns about recruitment and retention in the dental workforce and threats to NHS dental care are increasingly prevalent with limited empirical research from which to initiate evidence-based change.¹ A healthy workforce, in terms of numbers and well-being, are synergistically linked to satisfying careers, holistic personal development and overall workforce sustainability. This project explores the current workforce composition and establishes the needs and opportunities for workforce support and development.

Study design We employed a mixed-methods approach, distributing online surveys to dental staff and practices offering NHS and private care across the region. Additionally, we conducted qualitative analysis through focus groups at two major regional dental events, engaging a variety of stakeholders.

Results Most dentists are working less than full time, and underutilisation of staff skills persists despite staff vacancies. Since 2016, the numbers of dentists in the most deprived areas have decreased, and 48% of practices have decreased their proportion of NHS care. Sixty-five per cent of dental staff intend to reduce their working hours or leave dentistry in the next 5 years. Focus group data identified four key themes describing the influences on, and opportunities to support, dental workforce sustainability. These themes were careers, collaboration, costs and contentment.

Conclusion This study's findings are crucial for strategic planning that optimises workforce distribution and sustainability, ensuring quality dental care for the local population. Findings should inform discussion between NHS–England and stakeholders regarding essential education and training needs of the regional dental workforce as well as informing learning transferable throughout the United Kingdom.

Keywords: dental; focus groups; survey; sustainability; workforce

Reference

1. Evans, D., Burns L., Mills I., Bryce M., Hanks S., Recruitment and retention in dentistry in the UK: a scoping review to explore the challenges across the UK, with a particular interest in rural and coastal areas. Br Dent J, 2023: p. 1–7.

Charlotte Taylor, Pippa Watson and Matthew Jones

The University of Manchester

Background Clinical reasoning is the critical process in which clinicians gather and synthesise information to inform diagnosis and management.¹ It is imperative that educational strategies promote the development of this skill. The term ‘illness script’ was coined in 1984² and is based on theory from cognitive psychology.³ The term is often used to refer to a mental summary of a disease in the clinician's mind.² It is also sometimes used in the context of a tangible document that details the components of disease.

Aim This literature review aimed to explore the use of illness scripts in clinical reasoning and to consider how these might best be used to maximise potential learning.

Methods A literature review search was conducted using the databases EMBASE, MEDLINE, Cochrane and Web of Science. The search strategy included the terms ‘illness script*’ and ‘clinical reasoning’ and/or ‘healthcare education’ and was limited to manuscripts written in the English language with no date restriction.

Results Thirteen relevant manuscripts were reviewed. Of these, nine referred to illness scripts as mental representations, while four looked at tangible examples such as worksheets. Of these four, the majority found positive outcomes, such as improvement in clinical reasoning scores or qualitative reports of these being helpful.

Conclusions Illness scripts, particularly in the form of tangible learning tools, appear to have a role in developing clinical reasoning by providing a physical framework for educational practice. Further research is required to determine how these tools can be maximised to assist learners.

Keywords: education; illness script; learning; review

References

1. Daniel, M, Rencic J, Durning SJ, Holmboe E, Santen SA, Lang V, Ratcliffe T, Gordon D, Heist B, Lubarsky S, Estrada CA, Ballard T, Artino AR, Sergio da Silva A, Cleary T, Stojan J, Gruppen LD Clinical reasoning assessment methods: a scoping review and practical guidance. Acad Med 2019; 94(6):902–912.

2. Feltovich, PJ, Barrows, HS. Issues of generality in medical problem solving. In Schmidt, HG, deVoider, ML eds. Tutorials in problem-based learning. 1984: 128–170. The Netherlands: Van Gorcum.

3. Schank RC, Abelson, R. Scripts, plans, goals, and understanding. Hillsdale, NJ: Erlbaum Associates.

Sriraj Aiyer¹, Helen Higham² and Nick Yeung³

¹University of Oxford; ²Nuffield Department of Clinical Neurosciences, University of Oxford & John Radcliffe Hospital; ³Department of Experimental Psychology, University of Oxford

In this study, we investigated factors that informed diagnostic ability in medical students. We recruited UK sixth year students (N = 83) to perform six patient vignettes, diagnosing each patient's condition based on information provided in three stages: patient history, physical examination and testing. When participants were finished with requesting information at each stage, they recorded all considered diagnostic differentials alongside their confidence. We found evidence that differences in accuracy were associated with informational value/appropriateness and variance, but not with the amount of information. We found an association between confidence and information seeking, such that participants with more information reported higher confidence. This corresponds with previous work suggesting that having more information increases confidence regardless of if information is confirmatory of prior beliefs (Ko et al., 2022). We also found a general reticence to eliminate differentials from consideration.

To elucidate these findings, we conducted a follow-up study (N = 16) where students ‘thought aloud’ as they performed the same diagnosis task, with their utterances coded for reasoning strategies as per previous work (Coderre et al., 2003). We observed these strategies affected differential evaluation and accuracy, particularly when comparing hypothetico-deductive and pattern-recognition-based strategies. Previous work has tended to focus on evidence of under-/overconfidence in diagnosis relative to accuracy (Meyer et al., 2013). Our work indicates that confidence is more indicative of the information received rather than accuracy, with accuracy more determined by testing and reasoning strategies. This has implications for how medical students are taught diagnostic reasoning and uncertainty communication.

Keywords: decisions; diagnosis; foundation; psychology; uncertainty

References

1. Ko, Y. H., Feuerriegel, D., Turner, W., Overhoff, H., Niessen, E., Stahl, J., Hester R., Fink G. R., Weiss P. H. & Bode, S. (2022). Divergent effects of absolute evidence magnitude on decision accuracy and confidence in perceptual judgements. Cognition, 225, 105125.

2. Coderre, S., Mandin, H. H. P. H., Harasym, P. H., & Fick, G. H. (2003). Diagnostic reasoning strategies and diagnostic success. Med Educ, 37(8), 695–703.

3. Meyer, A. N., Payne, V. L., Meeks, D. W., Rao, R., & Singh, H. (2013). Physicians' diagnostic accuracy, confidence, and resource requests: a vignette study. JAMA Intern Med, 173(21), 1952–1958.

Younis Ahmad¹, Claire Stocker¹, Sophie Jones² and Elizabeth Dunn¹

¹Aston Medical School; ²University of Birmingham

Background Clinical reasoning is crucial for effective patient care but often lacks emphasis in current medical curricula. The UK Clinical Reasoning in Medical Education recommends explicit integration into taught medical courses.¹ We have developed an innovative approach to address this gap in learning, integrating artificial intelligence (AI) generated audio. We aim to create interactive e-learning resources focused on clinical reasoning providing a more authentic student experience.

Method Patient history scenarios were created using Articulate Storyline, with Murf AI generating audio, informed by the Medical Licensing Assessment. One hundred twenty-three second year medical students were evaluated pre- and post-session on the e-learning resource, usability, impact of speech AI on their learning and overall learning experience.

Evaluation Of those surveyed, 34 completed the pre-session survey, and 50 completed the post-session survey. Ninety-eight per cent reported speech AI e-learning improved their experience, and 94% reported improvement in scenario authenticity. All students reported that speech AI improved their diagnostic reasoning. Ninety-eight per cent felt that speech AI helped them use spoken information. Students commented that speech AI was authentic and simulated their experience in clinical practice.

Implications We report that speech AI in clinical reasoning exercises allowed students to replicate clinical practice by using spoken information. We envisage this will allow for the development of scalable, standardised teaching e-resources that students can use in a self-directed manner. We envisage implications for increasing inclusivity as resources reflecting a diverse range of patient demographics can be created and accessibility for students whose learning needs may benefit from reduced visual processing of information.

Keywords: artificial; diagnostic; intelligence; reasoning; speech

Reference

1. Cooper N, Bartlett M, Gay S, Hammond A, Lillicrap M, Matthan J, Singh M, on behalf of the UK Clinical Reasoning in Medical Education (CReME) consensus statement group. Consensus statement on the content of clinical reasoning curricula in undergraduate medical education. Med Teach 2021;43(2):152–159. https://doi.org/10.1080/0142159X.2020.1842343

Dilmini Karunaratne¹, Madawa Chandratilake² and Kosala Marambe³

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

Background The practice of medicine, while fulfilling, imposes a significant emotional weight on doctors.¹ This study examined the progression of clinical reasoning skills among junior doctors and incidentally discovered the emotional stress they experienced and its implications on the development of clinical reasoning skills. These findings are reported to enable better support for them during practice.

Methods A qualitative study employing a hermeneutic phenomenology methodology² was conducted using semi-structured interviews (n = 18) among immediate medical graduates at a main teaching hospital in Sri Lanka. The data were analysed thematically to identify recurring patterns in the data to explain the dataset.

Findings Junior doctors' emotional stress primarily stems from the difficulties associated with transitioning into a new role with increased responsibilities. This emotional strain is intensified by the demanding workload and time constraints. Inadequate support from senior medical staff and a lack of recognition of their contributions exacerbate the situation. Consequently, junior doctors become demotivated, contemplate changing careers and struggle to maintain compassionate attitudes towards patients. However, they do derive emotional support from close relationships with senior staff, peers and appreciative patients. Additionally, they employ coping mechanisms, including embracing challenges, adapting their practices accordingly, prioritising work commitments and finding reassurance in the noble nature of their profession.

Conclusion Healthcare institutions should prioritise the provision of a safe work environment, adequate support and mentorship from senior medical staff and value the contributions of junior doctors as integral members of the healthcare team to help overcome emotional stress and develop their clinical reasoning skills.

Keywords: clinical reasoning; emotional stress; junior doctors; medical decision making; qualitative research

References

1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014;12(6):573–576. https://doi.org/10.1370/afm.1713

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

Hannah Husain and Aishmeen Manesh

Lincoln Medical School

Introduction Lincoln Medical School is introducing a new curriculum as part of its journey to independence. While the GMC mandates a series of mandatory procedural skills for medical students to undertake,¹ the development of new technologies raises questions about the relevance of some of these skills in the long term. This project sought the views of clinicians on the skills required of medical graduates of 2030.

Methods Clinicians were invited to complete a short survey ranking all current mandatory procedural skills for relevance, the level of supervision required and the year of medical school they should be introduced. This survey was distributed to local clinicians through existing clinical networks.

Results Twenty-eight clinicians completed the survey; however, the sample was skewed towards GPs. The majority of current skills were thought to still be relevant for practice in 2030; however, only 79% felt that blood transfusion and IV infusions were still relevant for practice. All skills apart from point-of-care ultrasound were felt to require the ability to practise independently at graduation, with most skills recommended to be introduced in Year 3 of the course.

Discussion The survey results broadly support the current range of skills taught but indicate a desire to focus on independent practice with a move towards introducing skills around the traditional transition point from non-clinical to clinical teaching. This may indicate a desire for greater student engagement in practice or may represent a reflection of when clinicians felt they had first encountered these skills during their training.

Keywords: assessment; curricula; education; medical; teaching

Reference

1. General Medical Council. Practical skills and procedures. Published April 2019. Updated July 2023. Accessed 23 Jan 2024. https://www.gmc-uk.org/-/media/gmc-site/education/downloads/guidance/practical_skills_and_procedures_a4_july_2023.pdf

Jacqueline Driscoll, Judith Ibison, Jonathan Round, Joy Ferguson, Isabel Fernandes and Inny Oninuire

St. George's University of London

Background Effective handover of patient care is integral to safe, high-quality clinical care. It is a cornerstone of ‘Good Medical Practice’ as outlined by the General Medical Council.¹ However, surveys of foundation doctors indicate low confidence for participating in handover. Our phenomenological study investigates student experience of handover on placement to better understand the complexity encountered in shift handover² and the challenges students encounter in learning this skill.

Methods This study was facilitated by a staff student partnership grant from St. George's University of London and included three final year medical students and three clinical academics. Undergraduates were recruited and assigned to uni-professional focus groups: two medical student, one physiotherapy and one nursing (19 individuals in total). Focus groups were led by the final year students to encourage openness in a peer-to-peer environment. We chose a hermeneutic phenomenological design adopting the approach of Ajwii and Higgs for analysis. This enabled us to investigate the experience of being in handover ‘as it is lived, rather than as it is conceptualized’³ while simultaneously embracing our subjectivity of inhabiting a similar ‘lifeworld’ as our study participants.

Results Students are simultaneously learning the skill of handover and key clinical content from cases. Effective learning is impeded by a shortfall in clinical knowledge and acronym recognition that aid orientation, the compromise between service delivery and teaching and the chaotic environments in which handover takes place. Facilitators of effective learning included handover (ward) sheets that supported orientation, effective leadership and supported opportunities to practice.

Keywords: curriculum; focus groups; multiprofessional; qualitative; undergraduate

References

1. General Medical Council. Good medical practice. GMC; 2013. Updated 2020.

2. Cleland JA, Ross S, Miller SC, Patey R. “There is a chain of Chinese whispers …”: empirical data support the call to formally teach handover to prequalification doctors. Qual Saf Healthcare 2009; 18:267–271.

3. Ajjawi R, & Higgs J. Using hermeneutic phenomenology to investigate how experienced practitioners learn to communicate clinical reasoning. Qual Rep 2007;12: 612–638.

Jennifer Watson, Peter Yeates, Joanne Protheroe and Bappaditya Mandal

Keele University

Background Empathy is vitally important in healthcare and has noted benefits in terms of clinical outcomes and clinician–patient relationships.⁽¹⁾. Empathy is currently taught and assessed using rules-based frameworks that rely on the understanding of abstract notions. These may be difficult to interpret, may result in a sense of inauthenticity⁽²⁾ and can lead to varied interpretations during assessment. An alternative approach would be to exemplify empathy through a series of examples. Moreover, such a series could (at least theoretically) be used to train machine learning systems to automatically score empathy in clinical or educational settings. The purpose of this doctoral research is to develop a method to collect and rate examples of empathy (‘empathic moments’) from clinical consultations using judgements made by members of the public.

Methods Staff and students from Keele University (all faculties) observed videos of medical consultations online, pausing when they noticed empathy. At each pause, they rated empathy and indicated the behaviours responsible for their perception.

Results Ninety-five participants completed the study observing two to four videos each (from a set of 10 videos). Supporting the idea of ‘empathic moments’, initial analysis suggests that participants consistently select the same timepoints. Further analysis will compare rating consistency and attribution of behaviours to the perception of empathy.

Conclusions Our findings suggest a viable, novel means of creating a database of empathic moments (with associated ratings and explanations) for use in education. This dataset could be used to train an AI system to automatically score empathy, potentially enabling enhanced feedback in practice.

Keywords: communication; empathy; machine learning; OSCEs

References

1. Howick J, Moscrop A, Mebius A, Fanshawe TR, Lewith G, Bishop FL, Mistiaen P, Roberts NW, Dieninytė E, Hu XY, Aveyard P, Onakpoya IJ. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med 2018;111(7):240–252.

2. Laughey WF, Brown MEL, Finn GM. ‘I'm sorry to hear that’-empathy and empathic dissonance: the perspectives of PA students. Med Sci Educ 2020 13:1–10.

Ghaith Alfakrhy, Ariel Lindorff and Abdul Karim Ismail

Department of Education, University of Oxford

This research aims to evaluate the validity and utility of a tool to capture dental trainees' ability to self-assess their communication in authentic clinical encounters with patients.

The study will adopt a mixed-methods design. This research will take place at Damascus University Faculty of Dental Medicine from April to June 2024. The communication assessment tool will be developed based on the current theoretical model provided by the Calgary-Cambridge Observation Guide (Kurtz et al., 2017; Kurtz & Silverman, 1996); major themes will be investigated for their validity based on critical analysis of these themes using ethical and virtue theories as guiding principles. After refining the themes based on ethical and virtue considerations, the Delphi technique will be employed (De Villiers et al., 2005) to decide on the most relevant assessment domains and items to include. A total of 20 participants of clinical dental trainees will be recruited to test the designed assessment tool; this sample size will enable conducting appropriate statistical test robustly and aid in calculating the effect size to guide future studies. Participants will be assessed by 20 real unstandardised incognito patients who will undergo the same fixed prosthodontic treatment: a posterior bridge. Patients will fill a similar adjusted form to the one participants will fill in. Upon completion of treatment, semi-structured interviews will be conducted with patients to evaluate their perception of the dentist's communication. Qualitative data will be cross-analysed with quantitative longitudinal data collected via the assessment tool during treatment to assess tool validity and credibility.

Keywords: clinical dentistry; communication skills; mixed methods; self-assessment; validity

References

1. Kurtz S, Draper J, Silverman J. Teaching and learning communication skills in medicine. CRC Press; 2017.

2. Kurtz SM, Silverman JD. The Calgary—Cambridge referenced observation guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ 1996;30(2):83–89.

3. De Villiers MR, De Villiers PJ, Kent AP. The Delphi technique in health sciences education research. Med Teach 2005;27(7):639–643.

Hayley Boal

Mid Yorkshire Teaching NHS Trust

Background Escalating concerns and advocating for patients are essential components in maintaining patient safety in healthcare [1]. It was recognised by Mid Yorkshire Teaching NHS Trust that there was a deficit in teaching this to undergraduate medical students during their clinical placements.

Methods ‘Speak Up, Speak Out’ is a short session designed to equip final year medical students with a toolkit to escalate patient safety concerns. The session covers the importance of everyone's role in raising patient safety concerns and the perceived barriers to escalating concerns and teaches a graded assertiveness method: PACE, standing for probe, alert, challenge, emergency.

Results Prior to the session, 64% (53/83) of final year students reported that they had not received any teaching on graded assertiveness. Following the session, 100% stated that they would use PACE as a graded assertiveness method in escalating their concerns.

Discussion/conclusion Equipping final year medical students with a tool, such as PACE, empowers them to escalate concerns in the clinical environment. It is hoped that with this tool, reduced errors in the clinical environment will occur through their increased ability to escalate concerns and awareness of their key role, as observers, in recognising the potential for error.

Further work is required to implement ‘Speak Up, Speak Out’ for early years medical students, as well as the wider multidisciplinary team, with the potential for interprofessional learning opportunities.

Keywords: errors; escalation; safety; speak-up; undergraduate

Reference

1. General Medical Council. Raising and acting on concerns about patient safety. London: GMC; 2012. Available from: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/raising-and-acting-on-concerns

Olivia Jackson¹, Laura Williams¹ and Andrew Stein²

¹University of Warwick; ²University Hospitals Coventry and Warwickshire

Background Digital healthcare is becoming increasingly important, with more patients and practitioners turning to the Internet to answer health questions. It is also an important resource for clinicians to direct patients to where time for face-to-face education is limited.¹ The large quantity of information available online means that it is difficult to guarantee both patients and practitioners have access to accurate information. The application of search engine optimisation (SEO) techniques has shown to improve article performance, therefore increasing website visibility.² The application of these techniques in the digital healthcare industry could improve access to online medical educational material.

Method SEO techniques were applied to 13 articles, and their impact on article engagement was assessed. Four categories were used to assess engagement: number of users; number of views; number of views per user; and number of events. Data on these categories were collected, before the changes were made and 3 weeks after they were made, using the Google Analytics tool. A paired t-test analysis was performed to assess significance. The same approach was applied to 14 control articles.

Results A significant increase was seen across all four categories measuring engagement in the test group (p < 0.05). Across all four categories, 10 out of 13 articles saw an increase in engagement, two saw a decrease, and one article saw an increase in three categories and a decrease in 1. No significance was obtained in any category for the control group.

Conclusion This pilot study has shown that applying SEO techniques to healthcare articles can improve engagement.

Keywords: digital healthcare; education; medical; public; search engine optimisation

References

1. Buettner K., Fadem S Z., The internet as a tool for the renal community. Adv Chronic Kidney Dis. 2008 15(1):73–82. DOI: https://doi.org/10.1053/j.ackd.2007.10.002.

2. Wilson R F., Pettijohn J B., Search engine optimisation: a primer on keyword strategies. J Direct Data Digit Mark Pract. 2006 8: 121–133. DOI: https://doi.org/10.1057/palgrave.dddmp.4340563

Beth Robbins¹, Annie Price¹, David Hettle² and Grace Pearson³

¹North Bristol Academy, North Bristol NHS Trust; ²North Bristol Academy, North Bristol NHS Trust & University of Bristol; ³University of Bristol Medical School & Royal United Hospital Bath

Background Studies show that newly qualified doctors feel unprepared for clinical practice in several key areas in the care of older people,¹ despite older people occupying two-thirds of inpatient beds.² Grounded in experiential learning theory, simulation has been hugely effective in undergraduate education in geriatric medicine.³ We aimed to evaluate a novel simulation series exploring practically challenging aspects of geriatric medicine, such as ‘silver trauma’.

Methods We developed two inpatient simulation scenarios for fourth-year medical students on their geriatric medicine clerkships. The scenarios (managing delirium and post-falls assessment) are commonly encountered during on-call shifts, with learning outcomes aligned to Outcomes for Graduates. Our initial cycle involved eight students piloting the two scenarios and evaluation tool. Using their feedback, we will iteratively improve the methods and evaluation before repeating and obtaining pre- and post-simulation data on students' ‘preparedness for F1’.

Results Following the pilot, 100% of participants agreed that they felt more prepared for clinical work in geriatrics as an F1 doctor. 12.5% felt confident assessing a patient following a fall pre-session, which increased to 100% afterwards. Confidence in using de-escalation techniques in managing delirium improved from 50% (pre-session) to 100% (post-session). Common themes in free-text feedback were that the simulation felt realistic and effectively tested prioritisation.

Maximising potential Our work represents a novel approach to learning aspects of geriatric medicine which are emerging into undergraduate curricula. It highlights the merits of using simulation to help undergraduates prepare for the complexities and uncertainty involved in caring for the ageing population.

Keywords: delirium; geriatrics; simulation; trauma; undergraduate

References

1. Monrouxe LV, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, Mattick K How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014. BMJ Open 2017;7(1):e013656.

2. British Geriatrics Society 2023. Protecting the rights of older people to health and social care. Accessed 24 Jan 2024. https://www.bgs.org.uk/policy-and-media/protecting-the-rights-of-older-people-to-health-and-social-care

3. Fisher JM, Walker RW. A new age approach to an age old problem: using simulation to teach geriatric medicine to medical students. Age Ageing 2014;43(3):424–428.

Daniel Darbyshire¹, Rhiannon Conway², Alex Johnston³, Hattie Kennedy⁴, Jade Baker⁵, Geoff Haynes⁶ and Richard Parris⁷

¹Lancaster Medical School; ²Royal Manchester Children's Hospital; ³Emergency Department, Stepping Hill Hospital; ⁴Wythenshawe Hospital Emergency Department; ⁵Royal Oldham Hospital Emergency Department; ⁶Manchester University Foundation Trust; ⁷Health Education England North West

Background The third year of emergency medicine specialty training in the United Kingdom poses multiple challenges including a step-up in clinical responsibility, a large curriculum to cover and exams that must be completed to progress to Year 4. This has contributed to high levels of dissatisfaction and burnout. The attrition from training at the end of this year is much higher than in other years or specialities.¹

Balint groups have been used in mental health and general practice training aiming to develop reflective practice. Groups meet with a facilitator for 60–90 min every week or two and talk about difficult patient encounters.

Most research on Balint groups shows a positive learner experience and that the groups help develop reflective practice. A small number of studies suggest that Balint groups may also help reduce anxiety and provide relief from stress. Other studies show that they may help with burnout and improve work-related satisfaction.²

This study is the first to assess the impact of Balint groups on emergency medicine doctors. It aims to develop a holistic understanding of the impact of the groups, including any impact on resilience, retention and experience of work.

Methods Semi-structured interviews with Balint group participants, other Year 3 emergency medicine trainees and those involved in delivering the programme. Autoethnography from one Balint group participant.

Results The study is ongoing and the interim analysis will be previewed at the ASME ASM.

Keywords: Balint; medical; postgraduate; training; workforce

References

1. Kirkwood D, Darbyshire D, Mashru A, Hirst R. EMTA survey 2021. Emergency Medicine Trainees' Association. London, UK; 2022. https://www.emta.co.uk/_files/ugd/1e1e19_3d544bd2fd424fa48f7e448aff254d26.pdf

2. Kjeldmand D, Holmström I, Rosenqvist U. Balint training makes GPs thrive better in their job. Patient Educ Couns 2004;55(2):230–235. https://doi.org/10.1016/j.pec.2003.09.009

Steven Moore and David Hettle

North Bristol Academy, North Bristol NHS Trust

Background/Aim Clinical teaching fellows (CTFs) are increasingly involved in delivering undergraduate medical education, offering them opportunities to develop as educators.¹ Yet, without clear frameworks or training guiding development, they are often left unsupported, relying on their own initiative.² Therefore, we trialled a peer-led approach to promoting CTFs' educator development.

Methods Seven CTFs were recruited, who were observer and observee three times. Sessions included a pre-brief, observation and post-observation debrief using verbal and written feedback. Afterwards, written reflections were completed by observers and observees separately. A validated teaching observation tool,³ mapped to activities of the UK Professional Standards Framework, guided reflection on sessions including, case-based learning, simulation and small group teaching. Feedback on this programme via focus groups and a narrative review of written reflections will be completed following all observations.

Results Two observation cycles are completed, with final data collection ongoing. Provisional findings suggest this is a non-confrontational, informative process, both for observers and observees. Participants emphasise the impact on developing teaching techniques, session structure and promoting inclusion, while time constraints represent a challenge to regular peer observation. Final results will be presented at the ASM.

Discussion This innovation demonstrates great promise for supporting junior doctors' educator development in a sustainable way, promoting positive teaching practices and reflection. As CTFs have time to focus on medical education, these posts should be targeted by medical education leaders for supporting developing educators. Future work includes expanding the programme to include near-peer observation by senior CTFs and faculty.

Keywords: clinical teaching fellow; educator development; faculty development; peer observation

References

1. Couchman D, Donnachie D, Tarr J, Bull S. Clinical teaching fellows, the new norm? – experiences of fellows and education faculty. Clin Teach 2022;19(4):299–307.

2. Steinert Y. ‘Staff development’, in Dent J, Harden RN, Hunt D (eds.) A practical guide for medical teachers (5th). Edinburgh, Elsevier; 2017.

3. University of Bristol. Observation of teaching/supporting learning form 2021/22. University of Bristol; 2022. Accessed 22 Jan 2024. Available from: https://www.bristol.ac.uk/bilt/staff-development/teaching-observations/

Holly Christopher and Ritwik Banerjee

NHS England East of England

Background Limited formal exposure to radiology in the UK foundation programme could result in learning gaps for trainees, as well as exacerbate the projected radiology workforce shortage.¹ Recent expansion of innovative regional training ‘hub’ events in the East of England deanery offers dedicated teaching from radiologists, with dual aims of engaging foundation trainees with radiology and meeting key curricular requirements.

Methods A survey administered by NHS England East of England to gain feedback on three different radiology hubs across the region was completed by 15 foundation trainees.

Results All trainees surveyed would recommend the hub that they attended to others, and although the learning content varied between the different hubs, all but one of the trainees felt that the facilitators pitched the content at an appropriate level.

A majority of trainees (10/15) felt that hubs were best suited to virtual delivery, which allows larger numbers to benefit; however, the fact that some felt that in-person delivery (1/15) or offering both (4/15) was preferable supports a hybrid approach, providing additional opportunities for face-to-face networking where desired.

A minority of trainees (4/15) were planning to apply to radiology prior to attending (6/15 were not; 5/15 were undecided), and the survey showed that the hubs had either a neutral or positive effect on how likely they were to apply to radiology specialty training. This reinforces the use of hubs as viable models for promoting the specialty to reinforce the future radiologist workforce, as well as to provide targeted learning opportunities for foundation trainees.

Keywords: foundation; hub; postgraduate; radiology; teaching

Reference

1. Royal College of Radiologists. Clinical radiology UK workforce census 2022 report. Accessed 24 Jan 2024. Available from: https://www.rcr.ac.uk/news-policy/policy-reports-initiatives/clinical-radiology-census-reports/

Radhika Upreti Oli, Leyshon Griffiths, Robert Norman and Elizabeth Anderson

University of Leicester

Background It remains challenging to teach medical students with little understanding of front-line care about the importance of patient safety.¹ As appreciating theory aligned to practice is helpful, we sought patient safety practice approaches that offer immersive observational learning using safety tools.

Method The scoping review followed the JBI Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension.² We searched MEDLINE, CINAHL, Scopus, Web of Science and The Cochrane Library for primary papers published from 2009 to 2022. Papers were appraised for quality indicators and application of theory and were synthesised using Bigg's 3P theoretical model³—presage (setup), process (teaching) and product (evaluation and assessment).

Result From 8359 papers, eight papers were analysed. All studies claimed the use of a safety tool advanced students' learning and was often combined with monitoring real-time clinical practice. Students gained new knowledge, identified errors, valued team learning and felt better prepared to speak for errors. The studies explicitly discussed the process for observational learning but would be hard to replicate with a limited explanation of presage factors. There was less on outputs (product), as the studies were descriptive and atheoretical and assessment was often not described. The studies lacked rigour and adequate theoretical explanations about how learning occurred.

Conclusion The review shows that observational patient safety learning tools used in practice benefit students' understanding of patient safety and should be encouraged. Most studies are new, involve limited student numbers and yet could benefit practice. Further research is needed to clarify teaching design including assessment.

Keywords: 3P model; healthcare students; observational learning; patient safety; safety tool

References

1. Cresswell K, Howe A, Steven A, et al. Patient safety in healthcare preregistration educational curricula: multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses. BMJ Qual Saf 2013;22(10):843–854. https://doi.org/10.1136/bmjqs-2013-001905

2. Peters M, Godfrey C, McInerney P, Munn Z, Tricco A, Khalil H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI manual for evidence synthesis. 2020; JBI, doi: https://doi.org/10.46658/JBIMES-20-12

3. Biggs JB. The process of learning. In: Telfer R, editor. 2nd ed. Sydney: Prentice-Hall of Australia; 1987.

Vrinda Nayak, Jo Seale and Eleanor Townsend

University of Exeter Medical School

The medical curriculum requires adequate representation of diversity and inclusion to enable our future doctors to develop the knowledge, competence and skills required for caring for patients from diverse backgrounds. Our project aimed to determine the views of academic staff and students regarding the representation of issues related to diversity and inclusivity in Years 1 and 2 of the BMBS curriculum at the University of Exeter, with the long-term goal of reforming the curriculum to enable a transforming experience for our learning community. To achieve this, we used a three-pronged approach by reviewing the current curriculum using an evidence-based tool¹ to determine the extent to which each teaching resource represents six predefined EDI themes, a survey to collect student perspectives and a focus group to gain a deeper insight into their views. Ten student interns were recruited to conduct the written curriculum review comprising a total of 469 teaching sessions. They provided suggestions for enhancing the sessions through the incorporation of appropriate topics on these themes. The survey was distributed to all Year 1 and 2 BMBS students and a total of 231 students responded (response rate of 48%). The majority of students felt confident discussing the themes with their peers and were aware of the appropriate language to use, although this varied per the theme with religion and beliefs having the least awareness. The focus group comprising four students enabled us to identify four themes related to curriculum content and skill development for treating patients from diverse backgrounds.

Keywords: co-creation; curriculum review; equality, diversity and inclusion (EDI); future doctors; patient care

Reference

1. Wong SHM, Gishen F, Lokugamage AU, “Decolonising the medical curriculum”: humanising medicine through epistemic pluralism, cultural safety and critical consciousness. Lond Rev Educ 2021;19 (1), 1–22. https://doi.org/10.14324/LRE.19.1.16

Henrietta Croke and Rachel Napper

Northern LET

Background Facilitating formal teaching within a paediatric emergency department can be challenging. The environment and the nature of an ever-changing 24-h rota lead to many trainees missing out on learning opportunities. To try and combat this, we developed a virtual learning environment, available to trainees 24/7. This led to the development of a virtual grand round (VGR).

Methods Paediatric SHOs were asked to produce a case report, no longer than two sides of A4 of an interesting case seen within the department. These reports were then distributed weekly to all members of the paediatric team via email.

Surveys sent out to trainees following initial launch looking at barriers to production, thoughts on format and improvements suggested for future development.

Discussion Results from above have allowed us to develop a new, more user-friendly resource in the form of posters called paediatric bitesize cases available 24/7 throughout the department. Trainees are now provided with senior support and follow a pre-allocated rota with example cases and templates to help guide poster production. Repeat surveys are ongoing, and the results gained tailoring this teaching.

Keywords: learning from each other; postgraduate

Kaung Htet Hla Win and Fakhar Hussain

Nottingham University Hospitals NHS Trust

Clinical signs play a key role in assessment and diagnosis. The advance in diagnostic investigations could not substitute for the importance of clinical skill because the consideration and selection of investigations are mainly guided by clinical assessment. Recognition and correct detection of clinical signs can only be established through proper learning. It is worth noting that undergraduate medical curricula may see a decline in emphasis on learning physical signs, although intended learning outcomes require a breath of clinical skill in diagnosis. Unable to achieve this competency could subsequently lead to poor performance by medical students in high-stakes exams such as OSCEs. In contrast, studies found improved clinical communication skills in medical students with recent improvements in medical education. The scarcity of the opportunity to learn clinical signs due to the COVID-19 pandemic may continue even after graduation, widening the gap. The relative lack of these essential skills may lead to several important consequences, namely, missed diagnoses, wrong diagnoses and unnecessary tests.

Turning to possible solutions in undergraduate medical education, medical students were supported in the learning of physical signs by employing multimedia and problem-based learning (PBL) in addition to traditional bedside teaching. The assessment of learning using the feedback and level of confidence were positive. This project will supplement students in learning of these core competencies to prepare for bedside exams as well as their professional careers. The appropriate implementation of multimedia for such purposes will be discussed in detail, with further implications for postgraduate training.

Keywords: challenges; clinical signs; multimedia; problem-based

References

1. Pereira JC, Escuder MM. The importance of clinical symptoms and signs in the diagnosis of community-acquired pneumonia. J Trop Pediatr 1998;44(1):18–24. https://doi.org/10.1093/tropej/44.1.18

2. Faustinella F, Jacobs RJ. The decline of clinical skills: a challenge for medical schools. Int J Med Educ. 2018;9:195–197. https://doi.org/10.5116/ijme.5b3f.9fb3

3. Patil A, Ranjan R, Kumar P, Narang H. Impact of COVID-19 pandemic on post-graduate medical education and training in India: lessons learned and opportunities offered. Adv Med Educ Pract. 2021;12:809–816. https://doi.org/10.2147/AMEP.S320524

David Allard, Andrew Wood and Victoria Moye

University of Exeter

The student selected component of medical programmes allows students to study a topic of their interest at greater depth. Allowing students to follow their interests maximises their potential to obtain the research and scholarship skills taught through this component. A large diversity of topics maximises alignment of placements to student interest; hence, allocation of students to topics should be driven by the student choices. Ensuring fairness and equity of allocations is important to student satisfaction, which increases engagement and learning. The increasing number of students on medical programmes poses challenges to ensure systems are fair, align to student choice and maximise potential. Here, we report our technology-based solution and some lessons learnt.

Automated scripts to allocate students to projects have various benefits including incorporation of either student choice, supervisor preferences of students, maximising placement numbers or preventing the negative effect of informal pairing of students and supervisors.^1,2 We developed a script within R to allocate students to SSC placements based on student choices. The script reduces errors of cross-referencing multiple data sheets and is efficient for staff time. Comparison of manual and automated allocation highlighted some unexpected considerations to achieve maximal student and provider satisfaction. Our data show the effect on both students and placement providers of the maximum number of students a provider can be allocated, the number of choices each student provides and the number of placements compared to student cohort number. These may be considered when compiling a catalogue of student placements.

Keywords: allocation; placement; satisfaction; script

References

1. Abraham D., Irving R. and Manlove D. Two algorithms for the student-project allocation problem. J Discrete Algorithms (2007) 5(1): 73–90. https://doi.org/10.1016/j.jda.2006.03.006

2. Manlove D, Milne D Olaosebikan, Student-project allocation with preferences over projects: algorithmic and experimental results, Discret Appl Math (2022) 308: 220–234. https://doi.org/10.1016/j.dam.2020.08.015

Esme Turner

Harrogate District Foundation Trust

Background While the vast majority of healthcare prescribers are aware of the connection between antibiotic overuse and antibiotic resistance, 43% admit to starting antibiotics in the past week without believing they are indicated, with a similar proportion feeling they do not play a key role in controlling antibiotic resistance (1).

Aims To improve antibiotic prescribing culture in general surgical inpatients through empowering antibiotic stewardship in junior doctors to make informed decisions.

An online survey was used to evaluate the impact on junior doctors' affective skills surrounding antibiotic prescribing.

Outcomes Quantitative analysis using run chart rules showed a significant trend reduction in general surgical inpatients on intravenous antibiotics from 47% to 35%. Qualitative analysis suggested that junior doctors felt more able to share concerns about antibiotics during the microbiology ward round and more empowered to enact prescribing decisions after discussing with microbiology.

Learning points Regular antimicrobial teaching ward rounds can facilitate a change in culture through making antibiotic prescribing visible and junior doctor decision making valued. This can result in a significant reduction in general surgical inpatients on intravenous antibiotics.

Keywords: antimicrobial stewardship; education; empowerment

Reference

1. First-of-its kind survey reveals gaps in European healthcare workers' knowledge and attitudes about antibiotics. European Centre for Disease Prevention and Control. 2019. Accessed 22 May 2023. Available from: https://www.ecdc.europa.eu/en/news-events/first-its-kind-survey-reveals-gaps-european-healthcare-workers-knowledge-and-attitudes

Emily Green

Newcastle University

Higher education institutions, and therefore medical schools, have seen growing numbers of students with disabilities over recent years, and in particular, a rise in those reporting specific learning difficulties (SpLDs) or neurodiversity.¹ It can be challenging to determine the impact of SpLDs and being neurodiverse (ND) on students, as barriers to diagnosis and disclosure can make identifying these students difficult,¹ and many students may be unaware that they have these conditions. Nevertheless, there is existing evidence to suggest having an SpLD or ND condition can lead to disadvantages for students.² Within the field of medical education, current evidence focuses on a small subset of SpLDs, mainly dyslexia, and literature tends to be limited to their impact on assessment and the role of assessment adjustments. Lack of literature regarding the experiences of ND medical students has been noted previously.³ Here, a systematic scoping review was conducted to analyse the breadth and depth of existing pedagogic literature regarding the experiences and outcomes of medical students who are neurodiverse or have an SpLD. Keyword and MeSH searches were developed and implemented across several databases to identify all relevant articles. The review identified a paucity in the literature in this area, in particular with regard to specific guidance for appropriate teaching strategies for this student group. There is a need for future work exploring the most effective and inclusive teaching strategies within medical education to allow educators to create learning environments that can best meet the needs of an ever-diversifying medical student population.

Keywords: disabilities; education; learning; neurodiversity; review

References

1. Hamilton LG, Petty S. Compassionate pedagogy for neurodiversity in higher education: a conceptual analysis. Front Psychol 2023;14:1093290. https://doi.org/10.3389/fpsyg.2023.1093290

2. Jacobs L, Parke A, Ziegler F, Headleand C, De Angeli A. Learning at school through to university: the educational experiences of students with dyslexia at one UK higher education institution. Disabil Soc 2022;37(4):662–683. https://doi.org/10.1080/09687599.2020.1829553

3. Giroux M, Pelissier-Simard L. Shedding light on autistic traits in struggling learners: a blind spot in medical education. Perspect Med Educ 2021;10(3):180–186. https://doi.org/10.1007/s40037-021-00654-z

Li Wei Tan¹, Hugh Alberti¹, Paul Paes¹, Jan Iling² and Charlotte Rothwell¹

¹University of Newcastle Upon Tyne; ²The Royal College of Surgeons in Ireland

Background The progressive decline of empathy among medical students during their clinical years raises concerns, as empathy is integral to both patient care and the well-being of healthcare professionals. Recent reports such as the Ockenden Report¹ and the Francis Inquiry² suggest that empathy erosion has significantly impacted patient care and the overall health of practitioners. It is suggested that early intervention in medical schools can provide a positive outcome in addressing this issue.

One of the interventions implemented to potentially improve empathy erosion is the longitudinal integrated clerkship (LIC) model.³ The LIC model emphasises on medical students' involvement in comprehensive patient care over an extended period, fostering ongoing learning relationships with patients' clinicians and enabling the mastery of core clinical competencies across multiple disciplines simultaneously.

While extensive research supports the positive outcomes of LIC model in terms of patient-centeredness care and communication skills, the understanding of the aspects of LIC contributing to empathy development remains limited to date and requires further exploration and clarification.

Aim To explore the aspects of LIC model as an influence that contributes to empathy development among medical students.

Methodology A scoping literature review on the influence of LIC model and its aspects contributing to empathy in medical students will be conducted.

Anticipated result The findings of the scoping literature review will fill a literature gap by identifying aspects of LIC that shape empathy and understanding its influence on medical students. This will lay the groundwork for further research opportunities in this critical area.

Keywords: education; empathy development; longitudinal integrated clerkship; medical students; scoping review

References

1. Ockenden D. Final report of the Ockenden review. GOV.UK. March 30, 2022. Accessed 22 Jan 2024. https://www.gov.uk/government/publications/final-report-of-the-ockenden-review

2. Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry. GOV.UK. February 6, 2013. Accessed 22 Jan 2024. https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry

3. Gaufberg E, Hirsh D, Krupat E, Ogur B, Pelletier S, Reiff D, Bor D Into the future: patient-centredness endures in longitudinal integrated clerkship graduates. Med Educ 2014;48(6):572–582. https://doi.org/10.1111/medu.12413

Madina Amini and Anna Collini

King's College London

Background Since student characteristics largely depend on generational contexts, the adaptability of medical education is vital in meeting learner needs. While there has been substantial literature addressing the evolution of medical education for Millennials, Generation Z (Gen Z) is the current population in classrooms and the majority among recently graduated medical students.⁽¹⁾ Gen Z have grown up with ubiquitous access to technology, social media and the Internet, resulting in expectations of high interactivity, collaborative learning and instant gratification.⁽²⁾ This digital interface has not only shaped their learning preferences but has also influenced their social development, fostering a generation with less social engagement and increased mental health issues.

Moreover, Gen Z is characterised by intrinsic dedication to diversity and the promotion of equality and social justice, despite a formative upbringing marked by global turbulence.⁽³⁾

Methods Having identified three significant dimensions in Gen Z student needs and values—psychological, educational and social—this systematic literature review presents a holistic approach to medical education, where students should be at the heart and forefront.

Results Using my own positionality and reflexivity as a current Gen Z medical student, I aim to promote the student voice and encourage greater transparency and dialogue with educators. By offering adequate support in these three domains and accepting this student discourse, medical education has the potential to develop more effective strategies for ensuring the success of Gen Z in the field of medicine.

Keywords: change; dialogue; education; Generation Z; medical

References

1. Schenarts PJ. Now arriving: surgical trainees from generation Z. J Surg Educ 2020;77(2):246–253. https://doi.org/10.1016/j.jsurg.2019.09.004

2. Lerchenfeldt S, Attardi SM, Pratt RL, Sawarynski KE, Taylor TAH. Twelve tips for interfacing with the new generation of medical students: iGen. Med Teach 2020;43(11):1249–1254. https://doi.org/10.1080/0142159x.2020.1845305

3. Eckleberry-Hunt J, Lick D, Hunt R. Is medical education ready for generation Z? J Grad Med Educ 2018;10(4):378–381. https://doi.org/10.4300/jgme-d-18-00466.1

Leila Saeed¹, Amir Hakim, Aamenah Hawash² and Safiya Virji¹

¹Queen Mary's University of London; ²NHS England

Background In regions affected by conflict or natural disasters, medical education faces unprecedented challenges.¹ A disruption to clinical placements is a significant concern that threatens medical students' ability to graduate on time and serve their local populations. Medical Schools in Difficulty (MSID) is an inclusive e-learning platform designed to address the impact of this medical education inequality² by utilising skills and knowledge of UK healthcare professionals and educators.

Methods We assessed the feasibility of developing an online medical curriculum, benchmarked to the GMC's UK Medical Licensing Assessment (UKMLA),³ by supporting healthcare professionals, with varying degrees of experience in medical education.

Results Three hundred mainly UK-based clinicians contributed to the development of online content covering all 200 patient presentations and 24 areas of clinical practice mapped against the UKMLA. Content focused on history taking, examination and differential diagnoses to maximise value to a global online audience. All content was peer-reviewed by GMC-registered consultants and overseen by trained group supervisors. Of the 20 who received training, with minimal prior experience in medical education, 10 successfully took on additional supervisory roles. Since its launch, the MSID e-platform has been accessed by over 25 medical schools across 10 countries where medical education has been severely disrupted.

Conclusion MSID garnered support from more than 300 UK-based healthcare professionals to address educational inequalities in education. Contributors reported that excellent leadership skills from project leads and supervisors, centring around compassion, support and accountability, inspired them to be part of the MSID innovation.

Keywords: e-learning; innovation, global; medical; undergraduate

References

1. Dobiesz VA, Schwid M, Dias RD, Aiwonodagbon B, Tayeb B, Fricke A, Pham P, Erickson TB Maintaining health professional education during war: a scoping review. Med Educ 2022;56(8):793–804.

2. Barnett-Vanes A, Hassounah S, Shawki M, Ismail OA, Fung C, Kedia T, Rawaf S, Majeed A Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq. BMJ Open 2016;6(2): e010460.

3. General Medical Council medical licencing assessment. https://GMC-UK.org/mla

Amy-May Dicks

The Hillingdon Hospital NHS Trust

There is increasing evidence to support the importance of reflection in adult learning.¹ Reflective practice is also something clinicians are expected to demonstrate throughout their career, and how to reflect effectively is a skill in itself that can be developed.² Medical students are often already expected to write reflective pieces; however, many feel they do not have much guidance on how to do this. This quality improvement project aimed to provide students with frameworks to use for effective reflection, as well as to encourage students to incorporate more reflective practice to support their learning at medical school.

Small group teaching was delivered to third year medical students giving some guidance on reflective practice.

Students completed a pre-session questionnaire that was compared to a post-session questionnaire.

Most students (84.7%) agreed pre-session that reflective practice was useful for their learning. However, only 23.1% said they currently reflected regularly, but 95.5% agreed post-session that they intended to use more reflective practice. No students agreed before the session that they had a structure in mind to use for reflection, whereas 86.4% agreed they did post-session. The teaching was overall well received, with 90.9% agreeing they found it useful. Many of the additional feedback comments mentioned enjoying the opportunity to discuss and share their reflections with others in the session.

In conclusion, the students agreed this teaching helped provide them with more frameworks to use in writing reflective pieces and encouraged them to use reflection more often. Students may benefit further from more guided reflective practice.

Keywords: education; medical; reflection; undergraduate

References

1. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract 2009;14(4):595–621. https://doi.org/10.1007/s10459-007-9090-2

2. Cook K, Tillard G, Wyles C, Gerhard D, Ormond T, McAuliffe M. Assessing and developing the written reflective practice skills of speech-language pathology students. Int J Speech Lang Pathol 2019;21(1):46–55. https://doi.org/10.1080/17549507.2017.1374463

Bethany Jones

Bradford Teaching Hospital

UK medical graduates feel underprepared for taking leadership in complex decision making,¹ as is often necessitated when performing a medical clerking. A novel simulated session named introductory clerking experience (ICE) was built into the final year medical student curriculum to review and develop the students' confidence in the key responsibilities of a clerking doctor.

Fifty final year medical students from the University of Leeds participated in ICE, a 2-h simulation developed to recreate a common clerking case that would be seen as a newly qualified doctor. ICE necessitates the students use their history and examination findings alongside relevant investigations to formulate an impression and management plan. They then prescribe and suspend regular medications and initiate acute medications. ICE is facilitated and observed by a postgraduate doctor, who leads a focused debrief addressing student concerns and highlighting key learning outcomes. Students completed a questionnaire before and after the session, scoring their confidence in seven domains. This addressed the key responsibilities during a medical clerking to demonstrate how ICE impacted their confidence.

In all seven domains, students reported increased confidence following ICE. Students reported satisfaction from bringing multiple components of their medical curriculum into one session and felt the session helped them ‘think like a doctor’.

On-call simulated clerking such as ICE, which closely resemble the responsibilities of a junior doctor, is beneficial to student satisfaction and confidence. This integrated and experiential learning style increases student's complex reasoning and decision making to more closely mirror that of a postgraduate trainee.

Keywords: clerking; education; medical; simulation

Reference

1. Gale T, Brennan N, Langdon N, Read J, Keates N, Burns L, et al. Preparedness of recent medical graduates to meet anticipated healthcare needs GMC1203 final report. 2022.

Daniel Yi Liang Tan and Maria Hayfron-Benjamin

Barts and The London School of Medicine and Dentistry

Background Dyslexia in medical school is a common condition. With the COVID-19 pandemic, the medical school curriculum has changed. This might lead to differing experiences faced by medical students compared to previous literature.

Aim This paper explores the experiences of medical students with dyslexia post-COVID-19 with a focus on study methods and support.

Methods A qualitative study involving online interviews of five medical students with a formal dyslexia diagnosis was done. Data were collected over 2 months from February 2023 to March 2023. Transcripts were analysed using an iterative constant comparative approach, forming themes on the experiences of these medical students.

Results Participants experienced a general need to work harder than their peers in certain areas of medical school, especially with traditional learning methods. However, some participants also acknowledged strengths in other areas compared to their peers, especially concerning more visual areas of medicine. This is translated into study strategies whereby participants opt for different learning methods, adopting more visual, kinaesthetic and auditory approaches. Participants felt that more support should be given in making teaching resources more dyslexic friendly. While participants were more open in the disclosure of dyslexia, the aspect of raising awareness of the positive aspects of dyslexia in medical school was also raised.

Conclusion While there are more positive findings compared to previous literature, more effort needs to be made to support dyslexic students in medical school. Education of different members in medical school on the condition could also be actioned to reduce labels and stereotypes of it.

Keywords: dyslexia; education; medical school; medical students

Adrian Khaw¹, Lexzion Chung² and Richard Mak³

¹Department of Education, University of Oxford; ²University of Dundee; ³Royal Stoke University Hospital

Background The utilisation and complexity of simulation in medical education is ever increasing, accelerated by the emergence of novel techniques. Recent studies have identified the possibility of using medical simulation to develop both technical and non-technical skills (NTS). Despite this, challenges persist in effectively implementing NTS training due to the lack of a formal framework or guideline. We aim to identify effective strategies and analyse obstacles associated with integrating NTS training into undergraduate medical simulation.

Methods A comprehensive literature search was performed according to the PRISMA-ScR guidelines.¹ A search strategy was applied to PubMed, Scopus and Web of Science databases from inception until 5 January 2024. Studies that employed NTS in undergraduate medical simulation were included, while review articles and articles without involvement of medical students were excluded. The articles were independently screened by two reviewers, and conflicts were resolved through consensus. The included studies were then thematically analysed.

Results The initial database search yielded 331 articles. One hundred eighty-four abstracts were screened by title and abstract after duplicates were removed, 98 articles proceeded to full-text review, and 47 articles were included in the final analysis. The potential strategies identified for NTS training include delivering pre-simulation lectures, integrating video recordings, setting up simulated wards, implementing virtual reality, developing large-group and high-fidelity simulations, encouraging interprofessional collaboration and ensuring debriefing and feedback opportunities.

Conclusion The identified strategies were effective in cultivating NTS among medical students. These strategies may be incorporated into a structured framework for the delivery of NTS training in medical simulation.

Keywords: education; medical students; non-technical skills; review; simulation

Reference

1. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169(7):467–473. https://doi.org/10.7326/M18-0850

Jonathan Bardgett¹, Anda Bularga¹, Marilena Giannoudi¹, Kat Ralston¹, Libby Sampey¹, Natasha Armstrong², Christopher Graham², Timothy Johnson² and Isobel Macdonald Powney²

¹Trainees and Members' Committee (T&MC), Royal College of Physicians of Edinburgh (RCPE); ²Education, Training & Assessment Department, RCPE

Background Medical education podcasts (MEPs) are increasingly popular, favoured for their efficiency and educational/entertainment (‘edutainment’) value.¹ Recognising the need for remote medical education during the COVID-19 pandemic, the Royal College of Physicians of Edinburgh (RCPE)'s Trainees and Members' Committee (T&MC) launched the ‘COVID-19 Conversations’ MEP in March 2020, which evolved into ‘Clinical Conversations’ in August 2020, to meet the educational needs of medical trainees.

Methods This free MEP is designed by medical trainees, with feedback from RCPE event delegates and postgraduate curricula informing episode planning. Production aligns with MEP guidance.² Expert guests discuss key learning points, updates and reflections on clinical practice. Episode ‘show notes’ include links to guidelines and research discussed and further reading. Statistics are collated monthly from major podcast platforms: SoundCloud, Apple, Spotify and Google. Data collected since launch and podcast platform-provided analytics were reviewed.

Results As of 03/01/2024, 101 episodes have been released with >139,000 plays across major platforms, with 3280 SoundCloud/Apple/Spotify followers. For Apple (~37,000 plays; 27% of total plays), the top listener countries are the United Kingdom (86% of plays), Australia (3%), the United States (3%) and Singapore (1%), consistent with research demonstrating international use of MEPs.¹ Spotify age-based listener data support evidence that MEPs are adopted at all training levels.^1,3 Diverse specialties are represented in the most popular episodes. A sustained increasing average monthly listenership demonstrates the podcast's continued success. Feedback obtained at educational events guides development.

Conclusion ‘Clinical Conversations’ is a popular, free MEP for doctors-in-training used internationally.

Keywords: clinical; medical; postgraduate; podcast; education

References

1. Kelly JM, Perseghin A, Dow AW, Trivedi SP, Rodman A, Berk J. Learning through listening: a scoping review of podcast use in medical education. Acad Med 2022;97(7):1079–1085. https://doi.org/10.1097/ACM.0000000000004565

2. Berk J, Watto M, Williams P. Twelve tips for creating a medical education podcast. Med Teach 2020;42(11):1221–1227. https://doi.org/10.1080/0142159X.2020.1779205

3. Berk J, Trivedi SP, Watto M, Williams P, Centor R. Medical education podcasts: where we are and questions unanswered. J Gen Intern Med 2020;35:2176–2178. https://doi.org/10.1007/s11606-019-05606-2

James Murray¹, Emma Howie², Rory Clarke³, Nikki Totton⁴ and Adam Peckham-Cooper⁵

¹Sheffield Teaching Hospitals, University of Sheffield; ²Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Surgical Sabermetrics Group, University of Edinburgh; ³NHS England; ⁴Sheffield Centre for Health and Related Research, University of Sheffield; ⁵Leeds Institute of Emergency General Surgery, St James's University Hospital, University of Leeds

Introduction Performance-enhancing routines (PER) are commonly taught in professional sport to control emotion and optimise performance.¹ These lessons are applicable in surgery, where surgical expertise relies on the combination of cognitive processes and technical skills. The aim of this study was to evaluate whether teaching PER to trainee surgeons can reduce cognitive load and improve surgical performance.

Methods Inclusion criteria for participation were doctors with an interest in surgery, who were not on a Higher Surgical Training programme. Participants were randomised into a control arm and an intervention arm, with the intervention arm due to receive PER training. Participants were then asked to complete a range of supervised laparoscopic tasks, pre- and post-intervention, on a standardised laparoscopic box trainer. Data were collected on participants' subjective levels of cognitive load via questionnaires, objective levels of cognitive load via wearable physiological metric hardware and surgical performance via blinded expert analysis of video recordings using a validated scoring system.

Results Twenty-nine candidates attended for assessment. Fourteen candidates were randomised into the control arm, and 15 candidates were randomised into the intervention arm. Early findings from the data show promising results, indicating the benefit of PER in controlling subjective cognitive load.

Conclusion Modern surgical training focuses on technical skills and knowledge, but there are very few studies exploring surgeon performance and interventions to improve expertise. Early findings from this study indicate the benefit of PER in controlling subjective cognitive load, with more data regarding objective cognitive load and surgical performance awaited.

Keywords: education; metacognition; stress; surgery; training

Reference

1. MacIntyre TE, Igou ER, Campbell MJ, et al. Metacognition and action: a new pathway to understanding social and cognitive aspects of expertise in sport. Front Psychol 2014;5:1155.

Samuel Jack, Rachel Hughes, Amandeep Dhugga, Kehinde Oshodi, Charu Palta, Martyna Jankowska and Simon Tso

Warwick Hospital

Climate health is gaining prominence in the medical curriculum and the NHS has a statutory target to reach carbon net zero by 2040 (GHGP Scope 1 and 2).¹ Our project explored the carbon footprint of delivering different modalities of medical education to undergraduate students in a hospital setting (i.e. bedside, didactic and simulation), which is an underexplored area in the literature. We estimated the carbon footprint of consumables and energy used in the delivery of teaching sessions using three methods (heating, travel and food are excluded).

Life cycle assessment data from literature was used where available. A total of six teaching sessions were evaluated (bedside = 2, didactic = 2 and simulation = 2). Results showed the average carbon footprint for bedside, didactic and simulation teaching were 0.268 kgCO2e/h/learner, 0.047 kgCO2e/h/learner and 0.0303 kgCO2e/h/learner, respectively. Our findings showed that bedside teaching has the highest (due to use of PPE) and simulation has the lowest carbon footprint (due to reusable teaching resources). These are preliminary results and findings. Analysis of the full dataset (n = 30) is ongoing and will be available to present at the conference.

To the best of our knowledge, this is the first study to propose the use of kgCO2e/educator/h and kgCO2e/learner/h as a measure for evaluating medical education. This approach could be developed into a novel tool to evaluate and reduce the environmental impact of medical education departments.

Keywords: carbon; education; footprint; medical; sustainability

Reference

1. NHS England. Delivering a ‘net zero’ national health service. Published 2022. Accessed 25 Jan 2024. https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf

Muhammad Shahid Shamim¹ and Mirza Wasi Mohamad²

¹Aga Khan University; ²Mental Health and Well Being Services Ltd, Shrewsbury, UK

Have you ever wondered why there are so many successful professionals who constantly performed average or below academically in their university years? Could there be more of them?

Many students in universities have atypical learning abilities and cannot perform well academically due to the typical teaching and learning environment that persists in institutes. Many of these students fall within the neurodiverse paradigm. From a psychological perspective, neurodiversity, as opposed to the ‘neurotypical’ characteristics of the majority (1), is a strength-based approach to education that supports that various neurological conditions are the effect of normal changes in the human genome. It entails variations in people's cognitive abilities, giving them challenges and unique strengths.

In a typical educational environment, students with such unique strengths, by virtue of being different from the majority, pose a challenge for educators and struggle to learn and prosper (2). In developed contexts, such students are identified early in their educational journey and are assisted in the ways that best suit their learning abilities. However, in other contexts, including developing countries like Pakistan, the system for identifying diverse learning abilities is almost non-existent at every level (3). Therefore, students' atypical/diverse learning abilities are often not recognised, and they continue to struggle academically.

In this ‘What's your point?’ presentation, we debate the need for identifying and embracing (neuro)diverse learning abilities of academically low-performing students. Also, we share our plan for trying to achieve success for all learners so that no student is left behind.

Keywords: diversity; higher education; inclusivity; learning

References

1. Hamilton LG, Petty S. Compassionate pedagogy for neurodiversity in higher education: a conceptual analysis. Front Psychol 2023;14:1093290.

2. Clouder L, Karakus M, Cinotti A, Ferreyra MV, Fierros GA, Rojo P. Neurodiversity in higher education: a narrative synthesis. High Educ 2020;80(4):757–778.

3. Khalid M, Anjum G. Use of remedial teaching approaches for dyslexic students: experiences of remedial teachers working in urban Pakistan. Cogent Psychol. 2019;6(1):1580181.

Elizabeth Evens¹, Aysha Haddington-Ahmed² and Freya Dodgins¹

¹Newcastle University; ²South Tyneside and Sunderland NHS Trust

Many medical students observed recent studies demonstrating the prevalence of sexual misconduct within the NHS with alarm. A recent study found that one-third of female surgeons reported being sexually assaulted by a colleague.¹ Despite the magnitude of this problem, many medical students graduate with limited formal education on the topic; one-third of UK medical schools offer no teaching on sexual misconduct.²

To address this urgent issue, a team of medical students and a foundation doctor organised a training event at Newcastle University Medical School. The event encompassed sessions exploring how to support patients affected by sexual violence and support ourselves as we enter the medical workforce. Our presentation will reflect on the design and delivery of a case study session on sexual misconduct in the medical workplace.

These specially tailored vignettes sought to foster dialogue around feelings evoked, feminist theory and barriers medical students faced to reporting, in addition to sources of support available within the university, workplace and local community. Our presentation will evaluate the impact of this initiative through before-and-after surveys measuring participants' awareness of support and reporting systems for those affected by workplace sexual misconduct.

Our paper will speak to the suitability of a peer and near-peer education model for addressing sexual misconduct. We consider its potential limitations, reflecting on the importance of bringing together experts from the third sector, university well-being services and clinicians. We also suggest the potential benefits of this model in creating an appropriate and supportive environment to discuss these crucial issues.

Keywords: innovation; medical students; peer and near-peer education; sexual violence

References

1. Begeny, C.T., Arshad, H., Cuming, T., Dhariwal, D.K., Fisher, R.A., Franklin, M.D., Jackson, P.M., McLachlan, G.M., Searle, R.H. and Newlands, C. 2023. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. Br J Surg, 110 (11), pp. 1518–1526. https://doi.org/10.1093/bjs/znad242

2. Dowling, T. & Steele, S. 2023. Is sexual misconduct training sufficient in the UK's medical schools: results of a cross-sectional survey and opportunities for improvement. J R Soc Med Open, 14 (9) https://doi.org/10.1177/20542704231198732.

Charlotte Petrie, Sajni Gupta, Sarah Redford and Hugh Alberti

Newcastle University

Background The 2020 NHS Medical Workforce Race Equality Standard (MWRES) identified that Black and ethnic minority doctors are ‘underrepresented in academic positions’.¹

A recent study at our institution explored the reasons for a lack of interest in university posts in GP teacher applicants from ethnic minority backgrounds. Key findings were that there was perceived to be a lack of ethnically diverse role models at university level and a lack of ethnic diversity in GP trainees undertaking innovative training posts on a local training scheme. We sought to explore ethnic minority GP trainees' perceptions of careers in medical education and the barriers and challenges that surround this.

Method Ethical and HEE approval was granted. We held a focus group of ethnic minority GP trainees in November 2023. We had eight participants. The focus group was audio recorded, transcribed and thematically analysed.

Results Initial results were grouped into individual, institutional and cultural themes. Individual barriers included lack of teaching time and opportunities, balancing commitments and financial and poor experiences; institutional factors included teaching culture, system pressures and lack of diversity in role models; cultural factors included adapting as an IMG and perception of a different medical education structure in the United Kingdom. Enablers to careers in medical education and recommendations were identified.

Conclusion Our study has revealed several barriers that may be preventing GP trainees from ethnic minorities exploring a career in medical education. We would recommend further studies from other institutions to explore and confirm these barriers and have some initial recommendations to address them.

Keywords: diversity; careers; postgraduate; trainees; GP

Reference

1. NHS Medical Workforce Race Equality Standard (MWRES). WRES indicator for the medial workforce 2020. Published July 2021. Accessed 18 Jan 2024. https://www.england.nhs.uk/wp-content/uploads/2021/07/MWRES-DIGITAL-2020_FINAL.pdf

Rohini Sabherwal

Queen Marys University of London

Background Health equity is a critical problem in the United Kingdom, and we wanted to introduce and emphasise its importance to our students. As clinical lecturers working in east London, we developed three online flipped learning teaching days. Topics included pollution, BAME women's higher mortality rates in pregnancy and institutional racism.

Aims To evaluate student experiences and understand tutor experiences.

Methods Over 2.5 years, 1090 students and 19 tutors participated in the teaching. We collected online feedback from students after each session. We have 1120 anonymised student surveys. We also ran semi-structured focus groups to explore experiences. We used a qualitative mixed-methods approach. We evaluated the feedback using a phenomenological lens and analysed the feedback using a thematic model.

Results Themes included ‘high levels of student engagement’, ‘polarisation of student perception’ and ‘high levels of tutor satisfaction’.

The value students attached to this teaching was divided. Two groups emerged—one highly appreciated the importance and necessity of this teaching, and the counter group had a variety of reasons for dissatisfaction. Tutor engagement and satisfaction was high. Unexpectedly, tutors described positive changes in their own clinical practice.

Conclusions This teaching demonstrates the difficulties of challenging student values and beliefs. This can be complex for students to process. We believe this teaching represents transformative learning. We expected that self-selected tutors would have high levels of satisfaction. However, we did not anticipate changes in clinical practice and benefits to professional identity.

Keywords: engagement; health equity; medical students; primary care; undergraduate

Shiv Sharma¹, Saajan Basi², Moneet Gill³ and Ben Finch⁴

¹University Hospitals Bristol and Weston NHS Foundation Trust; ²University Hospitals of Leicester NHS Foundation Trust; ³Queen Victoria Hospital (East Grinstead); ⁴Imperial College Healthcare NHS Trust

Introduction IMGs are integral to the NHS, making up one-fifth of our workforce. One challenge they face is creating a competitive portfolio to secure a training number. Mentorship from individuals familiar with the system has been deemed essential to navigate the NHS. This pilot consists of a near-peer mentorship programme to empower IMGs applying for CST.

Methods Forty-five mentees are currently enrolled on a 12-month mentorship pilot. There are a total capacity for 25 mentors and 75 mentees. Mentorship design includes a combination of group and individual mentorship with a once per month meeting frequency. Mentorship impact will be assessed through feedback surveys pre-, mid- and post-mentorship. Primary outcomes will evaluate mentee confidence levels using a 7-point Likert scale assessing key portfolio domains including operative experience, teaching and quality improvement. Secondary outcomes will measure change in CST self-assessment score and number of stress-related absences.

Results Initial data from the pre-mentorship survey have been analysed (n = 45). Mentees report the highest confidence levels in operative experience with 22% strongly agreeing that they receive sufficient operative time. Contrastingly, mentees express the least confidence in research experience with 22% strongly disagreeing they understand how to participate in research. Sixty-seven per cent of mentees have had no training in teaching methods.

Conclusion This study assesses if there is significant benefit in offering mentorship to IMGs to aid their progression into CST. It will highlight if there is a need for formal, large-scale mentorship within NHS trusts to support workplace adaptation and career progression.

Keywords: careers; IMG; mentorship; near-peer; portfolio; surgery

Samuel Westaway, Natalie Hay, Kitt Richardson, Sadie Rawlinson, Huzaifa Adamali, Mustafa Elsayed and Samuel Taylor

North Bristol NHS Trust

Background In 2022, 52% of doctors who joined the NHS were international medical graduates (IMGs); however, IMGs are leaving UK practice at a higher rate than UK graduates.^1,2 In 2020, Black and minority ethnic staff were less likely to be appointed from shortlisting than White applicants and were more likely to enter a disciplinary process.³

Evidently, there is an increasing and pressing need to support IMG NHS induction.

Methods A 2-day course was designed for IMGs new to our trust as an induction to practising medicine in the United Kingdom. Sessions included but were not limited to human factors and teamwork training, a reflective writing workshop, an IMG expert panel and a well-being session.

Results Attendees' clinical experience ranged from 1 year to more than 10 years as doctors, all had trained abroad. All 13 attendees rated the overall induction experience as very good or excellent, with all agreeing they would ‘recommend the day to a colleague’. The well-being session and IMG expert panel sessions received the most positive feedback, with at least 75% of IMGs rating these as extremely useful. Suggestions to improve IMG induction included creating an IMG ‘buddy’ system, pairing new IMGs with existing IMGs with similar career backgrounds.

Conclusions A novel, specific-IMG induction course was extremely well received. Further research should follow up attendees to understand challenges they encountered when commencing clinical practice and if the course could be adapted to address any unmet needs. Creating an IMG ‘buddy’ system may also enhance the IMG induction experience.

Keywords: inclusivity; induction; international medical graduates

References

1. General Medical Council. Tackling disadvantages in medical education. General Medical Council; 2023.

2. General Medical Council. The state of medical education and practice in the UK. Workforce report. General Medical Council; 2023.

3. NHS Workforce Race Equality Standard Implementation Team. Workforce race equality standard report. NHS; 2021.

Kwaku Baryeh, Syeda Tasfia Tarannum, Antoniya Kamenova, Anna Bradley, Sadia Khan, Lara Higginson and Christina Cotzias

Chelsea and Westminster Hospital NHS Foundation Trust

Background International medical graduates (IMGs) often undertake clinical attachments prior to seeking NHS employment. This is intended to aid their acclimatisation and understanding of the UK healthcare system. However, most attachments are purely observation. At our trust, we wanted to redefine clinical attachment, and thus, the clinical attachment training programme (CATP) was born. Now in its second year, we look back at some successes from Year 1 and aspirations for the future of the programme.

Methods The CATP is a 2-week programme combining clinical observership with structured education tailored to the needs of IMGs. Evaluation surveys are conducted pre- and post-programme with regular follow-up with the candidates and post-programme support for finding employment.

Results Since June 2022, we have run six programmes with 183 candidates in total and an average of 31 candidates per course (range 19–40). Pre-course and post-course surveys were completed by 174 candidates (95% response rate). Confidence scores, out of five, in understanding the structure of the NHS and how to work within it increased from an average of 2.59 and 2.44 pre-course to 4.33 and 4.38 post-course, respectively. Fifty of our candidates (27%) have secured NHS employment following CATP attendance.

Conclusion The CATP represents an opportunity to support IMGs even before employment within the NHS. The tailored education programme improves candidates' understanding of NHS structure and how to work within it. It is a successful well-established model that can be grown and utilised to benefit many IMGs wanting to work in the United Kingdom.

Keywords: international medical graduates; orientation; pastoral support

Jack Inglis, Jack Miller, Erin McDonald and Rona Patey

University of Aberdeen

Having a rural background has been evidenced as the single biggest predictor of medical professionals practising in rural locations.¹ In response, this initiative introduces resource packs to promote healthcare careers among pupils in rural Scottish communities. Senior medical students on rural placement are then equipped to visit local schools, aiming to inspire and support potential healthcare professionals, as recommended by the Medical Schools Council outreach guidance.²

Exposure to healthcare careers from an early age is pivotal in cultivating interest and developing skills.³ Therefore, the first pack, through lessons on the multidisciplinary team and first aid, emphasises practical teamwork and communication among mid-upper primary school students.

Driving continuity from primary school onwards, the second pack introduces junior secondary school students to medical concepts through interactive lessons. Encouraging rural medicine, these sessions cover scientific and clinical aspects of common conditions and simulate emergency scenarios, offering practical insights into the necessity of healthcare practice in remote settings.

The third pack equips rural educators with the tools they need to guide students through the medical school application process. Digital posters and lesson packs provide timelines and essential information, fostering understanding and interest in studying medicine through undergraduate and alternative routes.

The ongoing pilot programme at Wick High School will gather feedback, informing adjustments and improvements. Although still in its infancy, this initiative holds promise in inspiring rural primary and secondary students to pursue healthcare careers, contributing to workforce diversity and addressing healthcare disparities in remote Scottish communities.

Keywords: applications; equity; outreach; resources; rural

References

1. Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2015;2015(6):CD005314. https://doi.org/10.1002/14651858.CD005314.pub3. Accessed 21 Jan 2024.

2. Medical School Council (MSC). A journey to medicine - outreach guidance. Published 13 November 2014. Accessed 21 Jan 2024. https://www.medschools.ac.uk/media/1205/msc-a-journey-to- medicine-outreach-guidance.pdf

3. Muncan B, Majumder N, Tudose N. From high school to hospital: how early exposure to healthcare affects adolescent career ideas. Int J Med Educ 2016;7:370–371. https://doi.org/10.5116/ijme.5801.f2cc. Accessed 21 Jan 2024.

Darush Azkhosravi, Danyal Mehrban and Emily Reid

University of Warwick

Background Muslim medical (MM) students comprise a significant portion of the United Kingdom's medical student cohort, witnessing a 146.4% year-on-year increase over a 7-year period.¹ Despite previous literature exploring diversity and inclusion in medical education, research addressing the experiences of Muslim students is limited, creating an information gap crucial for understanding this influential segment shaping the future healthcare workforce.

Objective Investigate the distinctive experiences, challenges and perceptions encountered by Muslim medical (MM) students in medical schools across the United Kingdom.

Design Qualitative study using semi-structured focus groups.

Methods Twenty-three medical students from graduate-entry and standard-entry courses were recruited for focus groups using snowball sampling; all students self-identified as Muslim.

Results Participants reported diverse factors shaping their medical school experiences, which we categorised into superordinate themes of individual, interpersonal and systemic factors influencing students' sense of belonging. MM students reported a convergence of barriers that negatively impacted their academic performance, well-being and sense of belonging: imposter syndrome, identity conflict, intersectionality, islamophobia, lack of cultural literacy, discrimination and gaslighting, lack of trust, exclusionary policies, fear and lack of support.

Students reported protective factors partially mitigated the impact of these when present: robust peer community, role models, imposter syndrome, inclusive social events, allyship, non-normative socials, cultural literacy, effective processes for raising concerns, support and trust in institutions.

Conclusion Cultural literacy in medical education fosters inclusivity for MM students. Targeted support, equitable representation and proactive measures are essential for well-being and addressing disparities. Further studies are essential to inform interventions for equitable career progression.

Keywords: belonging; education; medical; Muslim; undergraduate

Reference

1. General Medical Council. General Medical Council (2020) the state of medical education and practice in the UK: 2020 reference tables – medical students. General Medical Council; 2020.

Dominic Wiredu Boakye¹, Daniel Olaiya², Erin Walcon¹ and Vrinda Nayak¹

¹University of Exeter; ²Royal Free Hospital

Background In the absence of an impending deadline for racism,¹ the opinion of the authors here is to equip ethnic minorities to better deal with it. This becomes even more important for young people on clinical placements that are often in hospital trusts far from home and the protective umbrella of the university.² This is not another bystander training; instead, this resource firstly sensitises students to possible racial scenarios they may encounter in clinical placements and therefore makes them more mentally prepared for them. Simulations have routinely been used to train and build confidence in various high stakes professions such as surgeons and pilots.³

Method Here, we use the medium of acting to capture emotions that ethnic minorities experience when faced with racism in the workplace. The short clips will be used as the backbone to build a chose-your-own-adventure-style training resource. As learners engage with the true stories in the videos and observe these emotions play out in short clips, we aim to trigger a deeper level of understanding of issues faced by ethnic minorities but also empower students with a safe framework to appropriately respond to incidents of racism.

Expected outcomes The key outcome of this project would be an immersive e-resource that uses branching scenario technology to create a learner-tailored toolkit on how to deal with racism and microaggression. This toolkit will be incorporated into a face-to-face induction workshop that will be delivered to medical students.

Keywords: anti-racism; chose-your-own-adventure; empowerment; social mobility; video simulations

References

1. Eddo-Lodge R. Why I'm no longer talking to white people about race. Bloomsbury Publishing; 2020.

2. Montasem A, Gjuladin-Hellon T, Awan H, Aine B, Whyte J, Alqadah N, Ibeachu C. Racism, discrimination, and harassment in medical schools in the UK: a scoping review. Genealogy 2023;7(2):32.

3. Agha RA, Fowler AJ. The role and validity of surgical simulation. Int Surg 2015;100(2):350–357.

Miriam Stanyon¹, Nagina Kahn², Karl Ryan¹, Kirit Mistry³, Naina Patel⁴ and Subodh Dave¹

¹Derbyshire Healthcare NHS Foundation Trust; ²University of Leicester; ³South Asian Health Action; ⁴NIHR Research Support Service Hub delivered by University of Leicester and Partners, Dept of Population Health Sciences, University of Leicester

Background Patient involvement in medical education is required by policy¹ so that patients are fairly represented in the training of medical professionals. Communities described as ‘underserved’ by the NHS² are also underrepresented in medical education. Contact with these groups during medical training may foster future health professionals that are better able to give culturally appropriate care and encourage a greater uptake of services from underserved communities. This session describes an event bringing together individuals from underserved communities and other stakeholders to discuss the barriers and facilitators to increasing the diversity of patients involved in psychiatry education and research.

Methods Thirty-six delegates including 23 from a variety of ‘underserved communities’, 12 with a mental health condition, seven clinicians, nine researchers and three charity representatives attended an event entitled ‘Get your voice heard: Diversity in mental health education’. Delegates were placed into small groups, and the barriers and facilitators to being involved in psychiatry education and research were discussed. Group facilitators made notes and discussions were fed back to the whole group. Notes were later grouped thematically.

Results Barriers included (1) mental health stigma, both in certain cultures and the medical community, and the fear of discrimination, and (2) lack of awareness of mental health and opportunities for involvement. Facilitators included (1) NHS/university engagement with communities to educate about mental health and involvement opportunities and (2) decrease mental health and racial stigma within the medical workforce through cultural competence training. The barriers of language, finance and supporting patients involved in education were also discussed.

Keywords: BAME; community engagement; patient involvement; psychiatry

References

1. A National Service Framework for Mental Health. Modern standards and service models. 1999.

2. National Institute for Health and Care Research. Improving inclusion of under-served groups in clinical research: Guidance from INCLUDE project National Institute for Health and Care Research. National Institute for Health and Care Research. Published 7 August 2020. Accessed 15 Jan 2024. https://www.nihr.ac.uk/documents/improving-inclusion-of-under-served-groups-in-clinical-research-guidance-from-include-project/25435

Miranda Kronfli, Kerry Calvo and Megan Vaughan

UCL

The imperative to include issues of equity, diversity and inclusion (EDI) in postgraduate taught programmes in health professions education (HPE) curricula is evolving,¹ with renewed emphasis on avoiding foregrounding tutors' assumptions and creating a space for dialogue to take place and assumptions to be challenged. Yet, this remains an emotive and challenging topic.

As co-programme leads for a HPE master's, we include such topics in our curriculum with sessions entitled ‘Differential Attainment’² and ‘Educational Injustice’.³ Our iterative approach to developing this curriculum has meant: letting go of being attached to notions that faculty hold the subject expertise; positioning students as experts on their own lived experience; and responding with non-defensive curiosity to constructive feedback.

This feedback told us students took issue with our teaching about research-based ‘solutions’, available to clinical educators and supervisors to address EDI matters. Students found some terminology problematic, and the teaching undermined certain students' experiences of powerlessness in the workplace. Modifying our teaching to acknowledge the challenge presented by power imbalances has now resulted in feedback that students feel demoralised by the lack of available ‘solutions’, with some suggesting the topic should not be taught if there are no clear answers!

We propose a session that presents an overview of current theory and evidence in teaching about EDI, examines commonly used terminology and facilitates a safe space to ‘trouble the idea’ of how to raise this issue in a way that does not undermine experiences of powerlessness, yet is valuable to educators.

Keywords: differential attainment; education; equality; faculty development; postgraduate

References

1. Kusurkar, R. A., Naidu, T., & Rashid, M. A. (2023). How should we do equity, diversity and inclusion work in health professions education? MedEdPublish, 13, 31. https://doi.org/10.12688/mep.19673.1

2. Woolf, K., Rich, A., Viney, R., Needleman, S., & Griffin, A. (2016). Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open, 6(11), e013429. https://doi.org/10.1136/bmjopen-2016-013429

3. Sriprakash, A. (2022). Reparations: theorising just futures of education. Discourse: Studies in the Cultural Politics of Education, 1–14. https://doi.org/10.1080/01596306.2022.2144141

Dilhara Karunaratne¹, Andrea Pepper² and Jim Price²

¹Queen's Medical Centre, Nottingham; ²Brighton and Sussex Medical School

Background Widening accessibility to medicine has empowered the recruitment of students from disadvantaged backgrounds,¹ including those with disabilities and sensory impairments, such as those with hearing loss. However, the delivery of medical educational content to hearing impaired students can pose complex sensory challenges. This study's purpose is to discover the specific educational challenges faced by hearing impaired medical students and make achievable recommendations to both educators and students themselves to support their learning.

Methods Four hearing impaired medical students at a UK medical school underwent semi-structured interviews regarding their educational experiences. Interview transcripts underwent analysis using an interpretive phenomenological approach.

Results Hearing impaired medical students face multiple educational challenges in a variety of different educational settings. Some such challenges were related hearing loss, but others were due to lack of insight by medical educators and absence of accommodative measures to mitigate the effects of hearing impairment. Difficulties were further enhanced by wearing of personal protective equipment due to Covid-19. Some of these challenges can be mitigated by use of accommodative strategies, including adjustments to teaching style and technological innovation.

Conclusions The training of hearing impaired medical students is valuable in the delivery of holistic patient care, and efforts should be made to improve understanding of their educational challenges and provide them a safe, constructive learning environment. The recommendations made within this study may be useful in enhancing their education that may translate into betterment of patient care.

Keywords: best evidence medical education; education environment; medical education research; roles of teacher; staff development

Reference

1. Burke PJ, Hayton A, Stevenson J. Evaluating equity and widening participation in higher education. Trentham Books Limited; 2018.

Tomasz Pierscionek

Chelsea and Westminster Hospitals NHS Foundation Trust

Foundation year (FY) 1 and 2 doctors employed at one site of a central London teaching hospital are encouraged to attend weekly teaching where senior clinicians deliver lectures on topics mapped to the foundation programme curriculum. The curriculum also expects FY doctors to acquire teaching skills and seek feedback¹ to demonstrate their educational competency has been attained. The current postgraduate Medical Education Fellow (PgMEF) involved in coordinating the weekly FY teaching programmes introduced a peer-led teaching element to the structured weekly teaching sessions. A FY1-led journal club and FY2 peer-led teaching component has been introduced to augment learning opportunities. FY1 volunteers were sought to critically appraise papers, while FY2 doctors were asked to consider delivering bite-sized teaching on topics their colleagues find useful. These sessions last 15–20 min and are chaired by a PgMEF.

FY2 doctors have eagerly volunteered to deliver bite-sized teaching to their peers. Peer-led teaching gives them the opportunity to hone teaching and presenting skills (an essential skill for FY doctors) while also giving them active responsibility in identifying topics for deeper learning. Furthermore, FY2 doctors are more attuned to their colleagues' learning needs, and their presentations often generate discussion. FY1 doctors have so far been more reluctant in volunteering to present at the journal club, highlighting a need to include formal teaching on critical appraisal within their curriculum. The ability to critically appraise a paper is essential to enable clinicians to assess research quality and decide whether the conclusions should be incorporated into clinical practice.

Keywords: curriculum; doctor; foundation; peer; teaching

Reference

1. The foundation programme curriculum 2016. content.hee.nhs.uk. Accessed 25 Jan 2024. https://content.hee.nhs.uk/curriculum/learning-and-teaching.html

Harry Chappell¹, Pippa Dodd¹, Philip Davies² and Abigail Samuels²

¹Gloucestershire Academy, University of Bristol; ²Gloucestershire Hospitals NHS Foundation Trust

Background A challenge in medical education is motivation of students and busy healthcare professionals; here, extrinsic motivation provides limited benefit.¹ Self-determination theory suggests intrinsic motivation is more effective, with three underlying psychological needs: autonomy, competence and relatedness.² The ‘Learning from Excellence’ (LFE) programme is a positive feedback framework that has been shown to improve motivation in healthcare.³

This project aimed to explore the impact of an LFE project on motivation in students on placement and their clinical teachers.

Methodology An LFE project set up in January 2023 encouraged medical students and teachers to make nominations for self-defined excellence in Gloucestershire Hospitals NHS Foundation Trust. Between August and December 2023, it was continually promoted. Qualitative questionnaires were sent out at the start and end of this period for newcomers. These included 7-point Likert scales and blank-space questions focusing on intrinsic motivation.

The ongoing project will be surveying and interviewing individuals nominated to assess impact on intrinsic motivation.

Results Seventy-four LFE nominations were made during this period. Student questionnaires had 99 initial and 17 final questionnaire respondents. Teacher questionnaires had 21 initial and eight final questionnaire respondents.

Likert ratings improved in the domains of intrinsic motivation for students and teachers. Student comments highlighted a morale boost and encouragement from nominations. Students reported feeling empowered to acknowledge ward doctors teaching.

Discussion Results suggest that the LFE project had a positive impact on intrinsic motivation overall. Ongoing qualitative questionnaires and interviews will address to what extent it improves intrinsic motivation at an individual level.

Keywords: intrinsic motivation; learning from excellence; self-determination theory

References

1. Sobral DT. What kind of motivation drives medical students' learning quests? Med Educ 2004; 38: 950–957.

2. Gagné M, Deci E. Self-determination theory and work motivation. J Organ Behav 2005; 26: 331–362.

3. Kletter M, Plunkett E, Plunkett A, Hunt H, Bird P, Brown C. Impact of the ‘learning from excellence’ programme in NHS trusts: an exploratory study. Br J Healthc Manag 2020; 26: 1–10.

Sarah Allsop, James Lepoittevin, Clare Stoodley, Elise Thayer and Jo Howarth

University of Bristol

A key part of a medical student's training journey is receiving feedback on how they are contributing to and performing as part of a multiprofessional team. Bristol Medical School has embedded a validated multisource feedback process, known as ‘Team Assessment of Behaviour’ (TAB), used for trainee doctors, throughout the undergraduate curriculum [1–3]. Each year, over a period of 6–8 weeks, students complete TAB in their eportfolio. This builds in complexity to a replica of the postgraduate version for final year students.

A proportion of students in each year do not complete their TAB. Over time, we have introduced several interventions to support students through the process, including increased communications with both students and staff/assessors and introducing a visual timeline. While this has helped to decrease the number of non- completions, some students still repeatedly struggle to complete their TAB.

We sought to investigate the circumstances around this behaviour pattern. We conducted a retrospective analysis of data from 2017 to 2023 (50,000+ pieces of feedback), which showed that non-engagement with TAB is often accompanied by feedback around poor time management, planning and organisation. Importantly, students discuss their feedback with a trusted staff member/allocated mentor, enabling any concerns raised to be reflected on and resolved.

Our intention is that ongoing data analysis may help identify further interventions that, if introduced early would help all students, leveraging the full potential from the feedback practice of TAB. While particularly relevant for student feedback and growth, we hope such interventions could be translated to other areas of educational practice.

Keywords: assessment; engagement; multi-source feedback; professional development; undergraduate

References

1. Berk, RA. (2009). Using the 360° multisource feedback model to evaluate teaching and professionalism. Med Teach, 31:12, 1073–1080. https://doi.org/10.3109/01421590802572775

2. Donnon, T., Al Ansari, A., Al Alawi, S., & Violato, C. (2014). The reliability, validity, and feasibility of multisource feedback physician assessment: a systematic review. Acad Med, 89(3), 511–516. https://doi.org/10.1097/ACM.0000000000000147

3. Lockyer, J. and Sargeant, J. (2022). Multisource feedback: an overview of its use and application as a formative assessment. Can Med Educ J, 13:4, 30–35. https://doi.org/10.36834/cmej.73775

Emma Lewin and Karwai Tsang

King's College Hospital NHS Trust

Background At King's College Hospital, final year medical students undertake a 4-week placement on the acute medical unit (AMU), experiencing acute wards, ambulatory care and the medical take. Following reports of poor student engagement, this project aimed to obtain student perspectives on their AMU rotation and subsequently develop interventions to improve their experience.

Results Three PDSA cycles were completed, with a total of 17/19 students providing feedback. The overall rating (/10) of the placement increased with each cohort (6.7, 9.2, 9.5). There was also an overall increase in its usefulness (/5) for their exams and preparing for foundation years (3.3, 5, 5 and 3.8, 5, 4.25, respectively). Qualitatively, the features of the placement that students enjoyed were maintained during each cycle, while negative feedback reduced following the interventions. One hundred per cent of students agreed that each intervention was a valuable addition.

Conclusions This project demonstrates how using student feedback can meaningfully improve undergraduate experience on clinical placement. Student satisfaction significantly increased following the interventions, and students valued being included in the development of their placement.

Keywords: clinical; feedback; quality improvement; undergraduate

Andrew Swansbury, Millie Pierce and Kate Owen

Warwick Medical School

Background Feedback is an essential component of medical education, being an objective appraisal of the learner's performance, intended to improve their skills. Three of the most common feedback models used in medical education are: Sandwich, Pendleton and ALOBA.¹ These models have been previously compared from a theoretical standpoint, but limited empirical evidence exists as to which is best.²

Aim To begin to reduce this evidence gap by comparing the perceived effectiveness of each of the three models, in relation to the learning of clinical skills by first-year medical students.

Method Feedback was given by clinical skills tutors to first-year medical students learning clinical skills at Warwick Medical School using each of the models, rotated over a 3-week period. Questionnaires, containing free-text questions, were available for immediate completion by students and tutors.

Focus groups were also held, students and tutors separately, with 11 students and four tutors. Data were then analysed via thematic analysis.

Results Our results identified five key interlinked themes: emotional impact, self-reflection, targeted feedback, time to deliver feedback and evolution of preferred model. Separately questioned, students and tutors were consistent with each other in reporting that the most appropriate feedback model varies primarily depending upon the student's stage of learning.

Conclusion While each feedback model has its own associated advantages and disadvantages, the most effective feedback model evolves based on the student's stage of learning within first year. Sandwich is best used in the early weeks, Pendleton for the majority of the year and ALOBA in revision periods.

Keywords: clinical skills; feedback; models; undergraduate

References

1. Orsini C, Rodrigues V, Tricio J, Rosel M. Common models and approaches for the clinical educator to plan effective feedback encounters. J Educ Eval Health Prof 2022; 19:35.

2. Weallans J, Roberts C, Hamilton S, Parker S. Guidance for providing effective feedback in clinical supervision in postgraduate medical education: a systematic review. Postgrad Med J 2022; 98(1156):138–149.

Megan French

Bristol Medical School

Background With a growing number of foundation trainees, it is increasingly challenging to provide sufficient formal learning opportunities.¹ This is particularly true for simulation, a resource-intensive undertaking,² as evidenced in Severn Deanery within which only 57.1% of trusts were able to offer regular simulation opportunities for their foundation trainees. This project was created to improve the confidence of foundation doctors in leading simulation, with an overarching aim of cultivating a larger pool of skilled faculty capable of delivering simulation to future generations of foundation doctors.

Method Eighteen foundation doctors voluntarily joined undergraduate clinical teaching fellows to deliver simulation to medical students. Participants received pre-session guidance on facilitating simulation and structuring an effective debrief. Subsequently, a post-session questionnaire was used to capture participants' self-assessed confidence and knowledge surrounding simulation both before and after the session.

Results This intervention demonstrated a statistically significant 56% increase in participants' confidence levels regarding delivering simulation. There were also a 36% increase in understanding of how to plan simulation and a 42% increase in understanding of how a debrief is structured and facilitated. Notably, participants indicated a 30% greater inclination to pursue roles involving simulation teaching in the future.

Conclusion This educational innovation provided novel learning opportunities for current foundation trainees while increasing their intention to deliver simulation in the future. Although further longitudinal research is required to fully understand the impact of this intervention on future simulation provision, the potential benefits strongly advocate for the integration of this approach into the foundation curriculum.

Keywords: curriculum; faculty; foundation; simulation; undergraduate

References

1. Academy of Medical Royal Colleges. Medical student numbers: A report from the Academy Trainee Doctors' group. January 2023. Accessed 24/01/2024. Available from: https://www.aomrc.org.uk/wp-content/uploads/2023/01/Medical_student_numbers_ATDG_0123.pdf

2. Krishnan DG, Keloth AV, Ubedulla S. Pros and cons of simulation in medical education: a review. Education 2017;3(6):84–87.

Imogen Bishop¹ and Alexander Willson²

¹Bolton NHS Foundation Trust; ²Health Education North West

Objectives Understand the difficulties faced by medical graduates when managing critically unwell patients.

Design Qualitative study using mixed methodology including semi-structured interviews and vignette scenarios. Thematic analysis was used to analyse data, using an inductive approach, with coded themes derived from descriptive data.

Setting Interviews took place on Microsoft Teams with foundation programme doctors working at a district general hospital in the North West of England.

Participants Seven doctors, all UK medical school graduates, interviewed autumn 2023.

Results Looking after critically unwell patients is a significant concern for foundation doctors. Collectively, they felt they lacked the requisite experience and knowledge to manage critically unwell patients. Additionally, the senior support desired for managing such patients, and making decisions around their care, can be difficult to obtain, especially ‘out of hours’. Graduates felt that they had limited undergraduate exposure to critical illness, with simulation scenarios too simplistic to reflect the realities of multi-morbidity. Intensive care exposure, while helpful, was not universally available during medical school training.

Conclusions Medical graduates do not currently feel adequately prepared to manage critically unwell patients. Contemporary working practices are driven by resource and workforce challenges with an increasingly complex and co-morbid patient population.¹ Taking a significant role in managing a critically ill patient and the decisions involved therein is within the remit of foundation doctors, especially during ‘out-of-hours’ practice.² To better prepare graduates for the realities of working as a foundation doctor, it is recommended that critical illness exposure is increased, either through appropriate clinical experience or simulation.

Keywords: critical illness; medical graduates; qualitative research; undergraduate education

References

1. Bassford C. Decisions regarding admission to the ICU and international initiatives to improve the decision-making process. Crit Care 2017;21(1):174.

2. Clemente Vivancos Á, León Castelao E, Castellanos Ortega Á, Bodi Saera M, Gordo Vidal F, Martin Delgado M. C, Jorge-Soto C, Fernandez Mendez F, Igeño Cano, J. C, Trenado Alvarez J, Caballero Lopez J, and Parraga Ramirez MJ. National survey: how do we approach the patient at risk of clinical deterioration outside the ICU in the Spanish context? Int J Environ Res Public Health. 2022;19:1267.

Chloe Smith and Andrew Callaway

County Durham and Darlington NHS Foundation Trust

Background The transition from pre-clinical classroom-based teaching to learning full time on placement is notoriously challenging.¹ On placement, medical students frequently spend the most time with foundation doctors, who have had little training in teaching in the clinical environment. To improve medical students' experiences, we aimed to address the barriers to teaching and increase foundation doctors' confidence to teach in the clinical environment.

Methods We ran a workshop for F2 doctors, exploring and addressing the barriers to teaching in clinical environments. This generated themes to concentrate our efforts on for quality improvement.

Results Prior to and following the session, doctors rated their confidence out of 10 (10 = very confident) in teaching a medical student who was attached to their ward for the day. Pre-session, the mean was 6.8/10; this increased to 8.2/10 post-session.

The workshop resulted in the development of a Medical Student Handbook, which included an academic year timetable, core conditions/presentations for Years 3–5 and activities to undertake with staff and independently. Additionally, clerking booklets, documentation sheets and exam stationery were included so students could practise their skills without requiring a computer. Seventy-five per cent of students strongly agreed or agreed that the handbook improved their experience in clinical areas, while 100% of doctors strongly agreed that the handbook helped them when teaching medical students.

Discussion To improve medical student experiences on placement, the clinicians teaching need support and guidance. As educators, we should ensure clinicians are aware of local curriculums, necessary sign-offs and ways in which they can help students to succeed.

Keywords: barriers; doctors; education; teaching; undergraduate

Reference

1. vanHell EA, Kuks JB, Schönrock-Adema J, vanLohuizen MT, Cohen-Schotanus J. Transition to clinical training: influence of pre-clinical knowledge and skills, and consequences for clinical performance. Med Educ 2008;42(8):830–837. https://doi.org/10.1111/j.1365-2923.2008.03106.x

Hayley Boal, Joe Gleeson, Ashley Wragg, Courtney Johnson, Joe Thompson and Eleanor Clarke

Mid Yorkshire Teaching NHS Trust

Background The Mid Yorkshire Teaching NHS Trust developed a near-peer educational programme for FY1 doctors, STR1DE, to meet their requirement for 30 h of core teaching. Following the success of STR1DE, the trust recognised the lack of education provision for FY2 doctors and identified a need for a teaching programme for this group of ‘forgotten’ doctors.

Methods STR2DE (Simulation, Teaching, and Reflection for FY2 Development and Education) was developed and delivered by medical education clinical fellows (post-foundation doctors). Each of the 56 FY2s at the Trust attended three full-day STR2DE sessions per year, and it incorporates both clinical and non-clinical teaching topics, as well as crumbles and grumbles, a group reflective session. Data were collated from feedback from attending FY2 doctors over the three sessions.

Results Ninety-eight (49/50) of FY2s rated STR2DE overall good or very good on a 5-point scale. Its success, evidenced in feedback, was attributable to its specificity to FY2, relevance of topics, near-peer teachers and providing our FY2s with the opportunity to spend time with other FY2 colleagues, allowing learning from their peers.

STR2DE demonstrates a need for educational provision for FY2 doctors and that this can be successfully delivered by near-peer teachers. It also demonstrates the benefit of spending time with peers at the same stage of training and learning from each other through discussion.

STR2DE does, however, require a significant number of doctors to be released from clinical duties; therefore, strong institutional support is required.

Keywords: education; FY2; near-peer; relevance; workshops

Phoebe Brobbey, Benjamin Dickinson, Penelope Hurst and Amin Badri

Warwick Medical School, University Hospitals Coventry and Warwickshire NHS Trust

Background Gamification in medical education is an innovative phenomenon with a growing body of evidence to advocate its efficacy. Escape rooms have been utilised in wider education,¹ as well as specifically in medicine, to provide a more immersive learning experience. We discuss implementation and student experience of a medical escape room.

Approach Targeting curriculum gaps, we developed a multi-stage escape room with focus on continuity of care, following all steps of a patient's healthcare journey.

Methods An escape room was delivered to final year medical students during their internal medicine specialty block. Immediate online feedback was collated, with questions focusing on coverage of novel curriculum areas and overall learning experience. They were also surveyed on prior experience of escape rooms and previous exposure to primary–secondary care interfacing.

Results This novel approach was well received, with students describing the session as ‘really enjoyable’. They agreed the escape room helped to address areas of medical care not yet encountered during their specialty placements and resonated with the engaging approach to covering multi-stage care pathways.

Conclusion Although there is currently a paucity of evidence confirming the validity of such novel learning experiences within medical education, we feel this is an avenue with vast potential. We aim to continue running the escape room as described and to develop new scenarios to identify and address specific learning outcomes not easily met in the traditional curriculum diet. Further data collected will help us further contextualise the role of gamification and escape rooms within medical education.

Keywords: education; escape room; gamification; holistic; simulation

Reference

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

Nwe Aung¹, Safiyah Shah¹, Brenda Fineberg² and David Oakley¹

¹Buckinghamshire NHS Trust; ²Buckinghamshire

Background There is a growing acknowledgment in the literature of the importance of integrating prescribing and therapeutics skills into the medical curriculum for UK medical graduates.¹ Employing problem-based learning, a widely accepted approach,² we have innovatively transformed prescribing challenges into a snake and ladder board game, incorporating evidence-based gamification. This study outlines the development and assessment of a cost-effective and engaging board game aimed at enhancing prescribing skills.

Methods Third year medical students were presented with realistic clinical scenarios relating to endocrinology and gastroenterology, following patients' journey. Students were asked to solve clinical prescribing problems at the mouth of a snake or the bottom of a ladder. Tasks include management plans through emergency scenarios, drug chart reviews, patient communication information and calculation skills. After applying clinical reasoning and completing the task, facilitators provided real-time, personalised feedback. All the students are asked to commit to answers, with progression awarded for correct responses to the player character.

Results During self-evaluation, all students reported increased confidence in handling medications related to gastrointestinal and endocrinology conditions. Qualitative analysis indicated that students found the content relevant, and the gamified aspect added an enjoyable dimension to traditional learning.

Conclusion This innovative approach, combining problem-based learning with a gamified board game, demonstrates promising results in enhancing prescribing skills among medical students. The engaging and cost-effective nature of the intervention, coupled with positive student feedback, suggests its potential as a valuable addition to the medical curriculum for fostering effective prescribing practices.

Keywords: board game, clinical reasoning, fun, medical students, prescribing

References

1. Maxwell S, Walley T. Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow's doctors. Br J Clin Pharmacol 2003;55(6):496–503. https://doi.org/10.1046/j.1365-2125.2003.01878.x

2. Galvao TF, Silva MT, Neiva CS, Ribeiro LM, Pereira MG. Problem-based learning in pharmaceutical education: a systematic review and meta-analysis. Sci World J 2014;2014. https://doi.org/10.1155/2014/578382

Kehinde Oshodi

South Warwickshire University NHS Foundation Trust

We evaluated the effectiveness of the ‘Pain Game’, a 1.5-h gamified undergraduate revision session on analgesia with learning outcomes aligned to the requirements of Prescribing Safety Assessment and the UK Medical Licensing Assessment. It incorporated buzzers, touchscreen whiteboards and physical activities with team and individual case-based single-best-answer questions. Ten students from two medical schools were randomly allocated into teams by blindly selecting a colourful sweet. Participants completed anonymous pre- and post-session questionnaires with self-rating of their confidence on the learning outcomes via an 11-point Likert scale (1). The improvement in net promoter score (NPS) (2) reflects the confidence gained in the following areas: recognising the (a) indications for (−60 to +70), (b) side effects and complications of (−40 to +70), (c) contraindications of (−60 to +70) and (d) dose calculations of (−70 to +60) common analgesics. The five domains of the gamification taxonomy were ranked—social, then ecological, personal, fictional and performance—based on the motivating factors and effectiveness in attaining learning outcomes. The students ranked the four elements of the ‘social’ domain: cooperation, competition, social pressure and reputation. Students' overall perceptions of gamification in education improved, with NPS improving from −10 to +70. Students suggested more relevant inter-case activities and stronger feedback following each case. Students appreciated the co-operation and competition aspects of gamification (3). Time pressure, interactivity, buzzers, colours and case ranges were valued positively. Conducting student interviews and repeating the session should be considered. Future studies could explore the effectiveness of gamification in delivering education on other topics.

Keywords: medical; education; gamification; innovation; buzzers

References

1. Jebb AT., Ng V., Tay L. A review of key Likert scale development advances: 1995–2019. Front Psychol 2021;12:1–14.

2. Adams C, Walpola R, Schembri AM, Harrison R The ultimate question? Evaluating the use of net promoter score in healthcare: a systematic review. Health Expect 2022;25(5):2328–2339.

3. Sailer M., Homner L. The gamification of learning: a Meta-analysis. Educ Psychol Rev 2020;32: 77–112.

Nwe Aung, Aaron Joseph and David Oakley

Buckinghamshire NHS Trust

Background Addressing the knowledge gap in bedside examination and clinical sign interpretation is crucial for accurate clinical diagnoses and subsequent management plans.¹ Recognising the potential of gamification in medical education, we introduced a novel approach to reinforce clinical sign recognition through a memory picture quiz. As memory games have demonstrated effectiveness in primary school children for the ability to improve recall and memory while engaging the participants actively,² we aim to demonstrate similar result through this pilot study.

Method As part of a 3-h session on chronic liver disease, 17 undergraduate medical students engaged in a memory game designed to make learning enjoyable and effective. The game involved matching printed images of clinical signs of liver disease with their corresponding medical terms in small groups. The participants after completing the game were also given the opportunity to explain the description and pathophysiological processes underlying the matched cards to their peers. This qualitative study explores the participants' perception on the memory game through the semi-structured interviews.

This abstract provides insights into the development, implementation and initial assessment of the memory game picture quiz to supplement learning. The positive feedback and identified themes suggest the potential contributions of this gamified approach to medical education.

Keywords: clinical signal; interactive; memory game; undergraduate

References

1. Merriott D, Ransley G, Aziz S, Patel K, Rhodes M, Abraham D, Imansouren K, Turton D Will clinical signs become myth? Developing structured signs circuits to improve medical students' exposure to and confidence examining clinical signs. Med Educ Online. 2022;27(1). doi: https://doi.org/10.1080/10872981.2022.2050064, 2050064

2. Sivakumar R. Global and lokal distance education-GLOKALde. 2022. http://www.glokalde.com/pdf/issues/21/Article2.pdf.

Sarah Edwards¹, Aryana Zarandi², Michael Cosimini³, Teresa Chan⁴, Meilayi Abudukebier⁵ and Mikaela Stiver⁶

¹University Hospitals of Nottingham NHS Trust; ²Faculty of Health Sciences, McMaster University; ³Oregon Health and Science University; ⁴Toronto Metropolitan University & McMaster University; ⁵Anatomy and Cell Biology Program, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; ⁶Division of Anatomical Sciences, Department of Anatomy and Cell Biology, McGill University

Introduction Serious games are increasingly used in medical education to actively engage learners.^1,2 Analog serious games are a non-digital subset of serious games with specific purposes that go beyond entertainment. This scoping review intends to scan and describe the landscape of literature pertaining to analogue serious games over the last 10 years.

Methods We conducted a scoping review following the Arksey and O'Malley framework, searching three databases (Ovid MEDLINE, EMBASE and CINAHL) for studies of analogue serious games designed for physician-track learners published from January 2013 to December 2022. The extracted data was analysed for relevant themes and trends and then mapped to provide an overview of the field over the past decade.

Results The search retrieved 3401 records. After excluding 773 duplicates, 2628 items underwent title and abstract review. There were 163 full-text articles reviewed, and 72 met the inclusion criteria. A gradual increase in analogue serious games publications was recorded from 2013 to 2019. The most common types of scholarship included description studies (n = 52) and justification studies (n = 13). Dominant game formats were board games (n = 34) and card games (n = 31). Analog serious games were most frequently used among medical students (65%) and residents or fellows (44%). Studies determining reaction and acceptability (n = 31) were primarily noted.

Conclusions Analogue serious games were widely utilised in medical education for modifying the knowledge, skills and attitudes of physician-track learners. There is a broad spectrum of game formats in multiple fields. Future studies should evaluate analogue serious games to determine specific learner and system-level outcomes.

Keywords: game-based education; gamification; serious games; tabletop games

References

1. Gentry SV, Gauthier A, L'Estrade Ehrstrom B, et al. Serious gaming and gamification education in health professions: systematic review. J Med Internet Res 2019;21(3):e12994.

2. Xu M, Luo Y, Zhang Y, Xia R, Qian H, Zou X. Game-based learning in medical education. Front Public Health 2023;11:1113682.

Noreen Akram

Mid Yorkshire Teaching NHS Trust

Background An increasing body of evidence suggests that medical illustration and educational comics can facilitate interactive learning, increase student engagement and promote observational skills.¹

Historically, undergraduate medical students receive limited ear, nose and throat surgery (ENT) teaching and subsequently report low confidence in ENT competencies.² This pilot study reviews the use of educational comics to impart ENT clinical knowledge.

Methods ‘The Comic Chronicles: ENT Escapades’ 90-min interactive pilot session was delivered to 10 third year medical students on their ENT rotation. Forty-one students are due to complete the session by May 2024.

The session focused on three comic-boards, relating to key ENT presentations ‘discharging ear’, ‘epistaxis’ and ‘sore throat’. The comics demonstrated a patient journey with word blanks, questions and answers and visual clues. Students completed the storyboards collectively and presented the patient journey, facilitating peer learning.

Qualitative and quantitative data were collected via anonymised pre- and post-questionnaires.

Results Pre-session, students who felt confident in listing differentials, investigation and management for (i) epistaxis, (ii) sore throat and (iii) discharging ears were 30%, 60% and 20%, respectively. Post-session, this increased to 100% across all ENT domains.

Additionally, 100% of students agreed the comic teaching format encouraged teamwork, communication, application of knowledge and recall. All students ranked interactive group teaching above lecture-based teaching and remote learning.

Conclusion This pilot study found that educational comics can improve student confidence in ENT knowledge and facilitate development of integral observational skills.

Keywords: education; illustration; interactive; medical; peer learning

References

1. Green MJ, Myers KR. Graphic medicine: use of comics in medical education and patient care. BMJ. 2010;340:c863. https://doi.org/10.1136/bmj.c863

2. Powell J, Cooles FAH, Carrie S, Paleri V. Is undergraduate medical education working for ENT surgery? A survey of UK medical school graduates. J Laryngol Otol 2011;125(09):896–905. https://doi.org/10.1017/S0022215111001575.

Katherine Baker, Julia McLaughlin and Christopher James

Withybush General Hospital

Background International medical graduates (IMGs) make up approximately one-quarter of the total number of doctors registered with the General Medical Council.¹ The transition into a new healthcare system comes with ‘sociocultural and educational challenges’.² Previous IMGs in Withybush Hospital reported having ‘no support’ and described starting work as ‘dark times’, which highlighted the need for ‘effective, tailored support for IMGs’.³

Following each induction session, IMGs completed a questionnaire detailing their experience.

Results This tailored IMG induction has been facilitated for 12 new IMGs since September 2023. Feedback from the induction has been overwhelmingly positive including comments such as ‘I learnt a lot and definitely boost my confidence for on calls’ and ‘it was really helpful for me to get used to the system’. From direct observation, the medical education team were able to identify performance or knowledge gaps to provide feedback and further support.

Conclusion A robust multi-approach induction for IMGs is essential to reduce educational and sociocultural challenges, ultimately promoting effective and safe patient care.

Keywords: induction, international, postgraduate, simulation, skills

References

1. Hashim A. Educational challenges faced by international medical graduates in the UK. Adv Med Educ Pract 2017:441–445.

2. Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. Br J Hosp Med 2022;83(4):1–7.

3. Lineberry M, Osta A, Barnes M, Tas V, Atchon K, Schwartz A. Educational interventions for international medical graduates: a review and agenda. Med Educ 2015;49(9):863–879.

Ciska Uys, Alison Pearson, Daniele Carrieri and Karen Mattick

University of Exeter

Background Impaired wellness among junior doctors is a significant problem and improved connectedness is part of the solution (Carrieri et al., 2020). Shared social spaces in which healthcare staff meet informally improve connectedness; however, these spaces are in decline. Shared social spaces offer more than just a space for rest, but little is known about how this works and why. We aimed to investigate the impact of shared social spaces on wellness and learning of junior doctors.

Methods This realist evaluation began by creating an initial programme theory based on a scoping review (Uys et al., 2023), other literature and team discussions. We located all shared social spaces within a single hospital trust, characterised each space and took photographs. We observed five carefully selected spaces to understand interactions between junior doctors and other users. We undertook realist interviews with junior doctors based on the observation data. Data analysis developed and refined links between mechanisms, context and outcomes.

Results The mapping work identified 63 eligible extremely diverse spaces, ranging from informal practitioner-led spaces, such as one run by anaesthetists called The Gas Station, to more formal spaces that were sometimes beset by rules. Our programme theory provides an explanation for how social spaces work for junior doctors in this setting.

Discussion There are many diverse shared social spaces within healthcare settings, and they act to promote learning and wellness in complex and nuanced ways. This research provides stakeholders, managers and planners with an evidence-base that will help to preserve and improve them.

Keywords: clinical practice; learning and well-being; shared social spaces

References

1. Carrieri D, Mattick K, Pearson M, Papoutsi C, Briscoe S, Wong G, Jackson M. Optimising strategies to address mental ill-health in doctors and medical students: ‘care under pressure’ realist review and implementation guidance. BMC Med 2020;18(1):76.

2. Uys C, Carrieri D, Mattick K. The impact of shared social spaces on the wellness and learning of junior doctors: a scoping review. Med Educ 2023;57(4):315–330.

Hugh Alberti

Newcastle University

Background Competition between specialities could be considered a time old tradition and ‘part of the course’ when it comes to medical training. But at what point does ‘a bit of banter’ become a problem? It is no secret that the NHS needs more GPs, and yet positions remain vacant. Through this project, we aim to investigate whether denigration is contributing to the recruitment crisis.

Methods In 2016, the initial stage of this project confirmed our suspicion that denigration was occurring throughout the northern region and most concerningly was recognised by both junior doctors early in their careers and undergraduate students yet to embark on theirs (1). Since then, we have continued to collect data, via surveys, from medical students, foundation year doctors and GP trainees.

Results Eight years later and there is little positive to report. The number of trainees experiencing denigration is largely static, and few specialities appear to be entirely unaffected. While the 2023 data could be considered to offer a spark of hope, the themes identified within the comments reported remain deeply concerning. Whereas many specialities are referred to negatively due the competition for training contracts or demands of the job, criticism of general practice remains alarmingly focused on the idea it is considered a substandard and less valued career.

Discussion Interdisciplinary denigration continues unabated despite the turmoil of the Covid-19 pandemic and doctor strikes: When and how can we turn the tide?

Keywords: denigration; inter-speciality

Reference

1. Alberti, H., Banner, K., Collingwood, H., & Merritt, K. (2017). ‘Just a GP’: a mixed method study of undermining of general practice as a career choice in the UK. BMJ Open, 7(11).

Charu Palta

South Warwickshire University Foundation NHS trust

Background Various ongoing factors have contributed to reducing students' exposure to clinical paediatric activity. Simulation-based medical integrated and interdisciplinary learning environment (SMILE) is a 1-day immersive, interprofessional¹ innovation for medical and nursing students. They learn through realistic simulation scenarios each followed by OSCE-like extensions related to the original presentation but in different contexts.

Aims We evaluated the impact of SMILE on final-phase Warwick medical students' confidence in managing common paediatric conditions and perceived effects on professional skills like communication, documentation and prescribing.

Methods An anonymised 17-point questionnaire using Likert scales and free text was administered to participating students before and after SMILE. Research ethics committee approval was obtained. Data from 27 students across six iterations were analysed using descriptive statistics and paired t-tests.

Results Response rate was 100%. All respondents (n = 33) perceived SMILE as valuable for academic learning (mean score: 3.7/5 for OSCE extensions value addition). Confidence increased significantly in managing paediatric conditions (+1.4), communication (+1.4), prescribing (+2.0), documentation (+1.8), problem solving (+1.4) and other professional skills (+2.0) (p values < 0.001). Free-text feedback revealed themes of applying and building knowledge, peer and interprofessional learning, exam and skill development and timely feedback with resource signposting.

Discussion SMILE demonstrated potential to enhance learning from simulation to build confidence and skills in managing paediatric conditions. It facilitates interprofessional learning, integrates practical knowledge and cultivates professional skills relevant for exams and future careers. This constructivist approach² with extension tasks and real-time feedback is perceived as highly valuable by participants.

Keywords: integration; interdisciplinary; medical and nursing students; professional skills; simulation

References

1. Friedrich, S., Straub, C., Bode, S. F. N. & Heinzmann, A. 2021. SIESTA: a quick interprofessional learning activity fostering collaboration and communication between paediatric nursing trainees and medical students. BMC Med Educ, 21, 475.

2. Dennick, R. 2012. Twelve tips for incorporating educational theory into teaching practices. Med Teach, 34, 618–624.

Amisha Kalra

UCL

We investigated the impact of MedTech networking events on perspectives of medical, dental and veterinary students. We explored their understanding of MedTech careers and potential influence on career choices.

Given the increasing role of medical technology in healthcare and the need for professionals to acquire digital literacy skills¹ and broader networks,² there is a clear gap in formal education in these areas. Our study aims to assess the outcomes of initiatives addressing this need.

Our study, conducted in collaboration with the Royal Society of Medicine (RSM) Students Section, focuses on their inaugural MedTech networking event, titled ‘Building the Future of Medicine’. The event featured talks, structured speed networking and free networking sessions. The materials and methods involve a pre- and post-event survey with 12 questions, assessing participant demographics, understanding of MedTech careers, likelihood of pursuing non-traditional clinical paths and reasons for considering MedTech careers.

Results indicate increased understanding of MedTech careers post-event (mean of 6.94), with talks and structured networking deemed most useful. Despite a slight decrease in the self-rated likelihood of pursuing a MedTech career, the majority found the event valuable. This highlights the positive impact of heterogeneous events on attendees' perceptions of MedTech careers.

In conclusion, MedTech networking events play a crucial role in informing and engaging students about careers in the industry. The study suggests that a diverse format, including talks and structured networking, enhances the effectiveness of such events in preparing the healthcare workforce for the evolving landscape of digital healthcare.

Keywords: innovation; interdisciplinary; MedTech; networking; professional

References

1. Stoumpos AI, Kitsios F, Talias MA. Digital transformation in healthcare: technology acceptance and its applications. Int J Environ Res Public Health. 2023;20(4):3407. https://doi.org/10.3390/ijerph20043407. PMID: 36834105; PMCID: PMC9963556.

2. Salib S, Hudson FP. Networking in academic medicine: keeping an eye on equity. J Grad Med Educ. 2023;15(3):306–308. https://doi.org/10.4300/JGME-D-22-00546.1. Epub 2023 Jun 14. PMID: 37363681; PMCID: PMC10286928.

Helen Ireland¹, Ellen Williams¹, Marc Miell² and Nick Haddington²

¹Pharmacy Workforce Development South; ²NHS England South West

Background Specialist mental health pharmacist's roles are expanding¹ with potential diagnosis training needed. To consider this, NHS England School of Pharmacy piloted pharmacists joining 6-month core trainee (CT) psychiatry training.

Aim To explore benefits and challenges of pharmacist prescribers participating in CT psychiatry training from stakeholder perspectives (pharmacists and CTs on course, pharmacists' line managers and service users).

Method A qualitative methodological approach was adopted. One-to-one semi-structured interviews with each pharmacist at start and end of training. Line managers invited to one-to-one semi-structured interview. Service users and CTs contributed by qualitative e-questionnaire. Thematic analysis across all data.² Study did not need NHS ethics as service evaluation.

Results Four pharmacists interviewed at start, and three at month 6. One line manager (response rate 33%) interviewed. Fourteen service users and eight CTs (response rate 23%) participated in e-questionnaire.

Pharmacists' and line managers' accepted specialist roles required further training, ‘more training than prescribing course’ (Pharmacist A). Benefits were recognised: ‘This training is extension of multidisciplinary clinical team’ line manager.

All CTs supported pharmacists dispensing. One CT welcomed pharmacists prescribing. All CTs disagreed to pharmacists diagnosing mental health conditions. Four (50%) CTs supported learning with pharmacists: ‘useful to learn with and from pharmacists’ (CT5).

Eight service users (62%) were unaware pharmacists did more than dispensing but embraced specialist roles; ‘appointment with pharmacist … is great’ (Respondent 7). All service users agreed to health professionals learning together.

Conclusion Benefits included interprofessional learning and augmenting workplace multidisciplinary relationships. Challenges, such as unawareness of pharmacist roles, were noted.

Keywords: interprofessional; mental health; patient; pharmacists; psychiatry

References

1. Health Education England. A review of innovative and extended roles within mental health pharmacy; 2020. Accessed 24 Jan 2024. Report template (hee.nhs.uk).

2. Braun, V. and Clarke, V. Thematic analysis: a practical guide. 1st ed. London: SAGE Publications Ltd; 2021.

Ashley Wragg, Emma Broadhead, Emma Jones, Joe Thompson and Hayley Boal

Mid Yorkshire NHS Teaching Trust

It is established that hierarchical barriers in healthcare have played a major role critical incidences and have prevented nurses from speaking up to senior nurses and doctors during medical emergencies.^[1] One such emergency situation is cardiac arrest, and we investigated whether interprofessional simulation with final year nursing and medical students could improve nursing students' ability to speak up in medical emergencies. At Mid Yorkshire Teaching Trust, we introduced an interprofessional cardiac arrest simulation day, taught by senior A&E nurses and clinical fellows in medical education. Data were obtained from the nursing students (n = 12) via pre- and post-course questionnaires, rating their confidence in speaking up to HCPs. The majority of nursing students have wanted to raise concerns in clinical practice (73%), but only 14% have. This coincided with only 28% of nursing students feeling confident speaking up in medical emergencies prior to the course. This was mainly due to fears of not being listened to and dismissed. Following the course, there is a 63% increase in students feeling empowered to raise a concern during a medical emergency (pre: 28%, post: 91%), which was supported by a dramatic improvement in students' confidence in speaking up senior sisters and doctors, with all students stating they were now confident in speaking up to these HCPs. Interprofessional cardiac arrest simulation with final year nursing and medical students can improve nursing student confidence to speak up in medical emergencies and may empower them to do so in their postgraduate careers.

Keywords: empowering; hierarchy; interprofessional; speaking up

Reference

1. Morrow, Kelly J., Allison M. Gustavson, and Jacqueline Jones. “Speaking up behaviours (safety voices) of healthcare workers: a metasynthesis of qualitative research studies.” Int J Nurs Stud 64 (2016): 42–51.

Nadia Lascar¹, Claire J. Stocker, Noor Al-Antary, Joseph Cowling and Wendy Leadbeater²

¹Aston Medical School; ²University of Birmingham

Background Recently, the role of CTFs in medical education has evolved from principally bedside teaching to facilitating learning of biomedical sciences and clinical skills during the early years.¹ Some aspects of their role involve working with students in a near-peer capacity, offering pastoral support and mentorship.² Our study explored which attributes of CTFs were perceived by themselves, students and staff, as useful to enhance the learning experience in early years medical education.

Methods We conducted focus groups and surveys inviting 422 MBChB students, five CTFs and 31 faculty members, to explore perceptions of CTFs' role in the first 2 years of the programme. Data were investigated by descriptive and thematic analysis³ for 102 students, five CTFs and 15 staff.

Results The most valued attribute for students was being helpful/supportive (19%), the second highest for staff (53%). For CTFs, the highest ranked attribute was being friendly/approachable (60%), while for students, this ranked second (17%) and staff sixth (13%). In contrast, the most valued attribute for staff was effective facilitation (73%), which ranked fourth for students (9%) and tenth for CTFs (20%). Qualitative analysis showed participants interpreted being helpful/supportive as sharing stories/experiences and offering career guidance and being friendly/approachable as being relatable and building connections with students. Effective facilitation was interpreted as providing academic support.

Conclusion Attributes associated with pastoral care and professional development were highly perceived by students and CTFs. Staff should be encouraged to consider CTF mentorship role as valued contributor to the learning experience in early years medical education.

Keywords: clinical teaching fellow; education; MBChB; near-peer; pastoral

References

1. Harris, I.M., Greenfield, S., Ward, D.J., Sitch A.J., Parry J. The clinical teaching fellow role: views of the heads of academy in the West Midlands. BMC Med Educ 2023; 242. https://doi.org/10.1186/s12909-023-04219-y

2. Woodfield G, O'Sullivan M. Clinical teaching fellows: everyone's a winner. Clin Teach 2014;11(2):136–140. https://doi.org/10.1111/tct.12084. PMID: 24629252.

3. Ritchie, J., L. Spencer and W. O'Connor. Carrying out qualitative analysis. In Qualitative research practice. London: Sage;2003.

Ciara Gavin¹, Charlie Williams¹ and Alex Brightwel²

¹University of East Anglia; ²Norfolk and Norwich University Hospital

Cases of child abuse (CA) are more commonly missed than detected in clinical practise.¹ The GMC commented that it is surprising that no studies have evaluated the educational activities used to prepare students for this difficult area of clinical practice.² This qualitative study therefore explores the barriers in clinical practice that limit the recognition and reporting of child abuse by senior medical students. The pilot study created an evidence base of student's learning needs. We answered the following research questions: (1) Does the type of child abuse affect students' abilities to recognise and report it? (2) What barriers do medical students face when considering reporting suspected child abuse on placement? This single-site study consists of three steams. Steam A received an anonymous questionnaire consisting of questions based on five simulated case vignettes; four should raise concerns about potential child abuse and one a red herring. Stream B completed a questionnaire before gathering as a focus group to discuss the barrier and their thoughts on future educational activities. Stream C consisted of a semi-structured interview with a member of UEA Outreach Safeguarding team to discuss their experiences of teaching students about child abuse and reporting. Thematic analysis was undertaken to determine the key barriers to recognising and reporting CA and students' perceptions of how previous educational activities have translated to clinical competence. Results indicate that emotional abuse is harder for medical students to recognise and that more confidence building activity is needed in medical education.

Keywords: abuse; education; medical; paediatrics; undergraduate

References

1. National Society for the Prevention of Cruelty to Children. How safe are our children?. Published 2013. Accessed 13 Nov 2023. https://childhub.org/sites/default/files/library/attachments/1599_how-safe-2013-report_wdf95435_original.pdf

2. General Medical Council. Protecting children and young people: the responsibilities of all doctors. Published 2018. Accessed 13 Nov 2023. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/protecting-children-and-young-people/about-this-guidanc

Elizabeth Walden, DaHyun Chung, Deema Alyousuf, Jemima Marsden, Muthukumaraswamy Thirumalaiappan, Samali Pathira Kankanange and Rachel Ashworth

University of Worcester

The MBChB at Three Counties Medical School is a new graduate entry medical degree, centred around problem-based learning (PBL). The PBL model, with an emphasis on collaborative, student-centred, self-directed learning, is widely used in medical education (1). This educational approach develops key skills, such as problem solving, knowledge acquisition and enhanced group collaboration, in preparation for practice. PBL is very different from traditional classroom teaching, requiring resources that support self-directed group learning outside the classroom. Evidence shows that students enjoy this style of autonomous learning; however, there are disadvantages (2). Our research project will create student-generated online resources that support self-directed learning within the first year of our medical degree. Initial discussions have identified several areas that could potentially benefit from the creation of resources. We are now in the process of surveying our Year 1 students to establish the topics and types of support (e.g. ‘capturing concepts’—mind maps/visual resources or ‘creating formularies’—drugs, infection and disease) perceived as most useful. Based on the pre-project questionnaire, resources will be generated and shared with students via the VLE (Blackboard). The platform will provide easy access to resources and allow the study team to monitor usage. Participants will be resurveyed at the end of the academic year to assess the extent to which resources supported their learning. By generating online learning resources to support self-directed learning from a student perspective, we hope to create innovative tools that can be shared more widely within the educational community.

Keywords: learning resources; medical education; online; problem-based learning

References

1. Trullàs. et al. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC Med Educ (2022) 22:104.

2. Jones RW. Problem-based learning: description, advantages, disadvantages, scenarios and facilitation. Anaesth Intensive Care 2006;34(4):485–488.

Liza Fernandes, Erin McQuillan, Rebecca Glendell, Alekh Thapa, Emma Bailey, Lauren Horsburgh, Mairi Docherty, Neha Jose and Callum Williams

University of Glasgow

Background Medic Insight Glasgow is a medical student-led organisation providing events for prospective medical students and promoting widening participation (WP). We analysed our events with before–after surveys, identifying deficits in career and application advice in WP participants (presented AMEE 2023¹). We aimed to understand whether our events effectively reduce this deficit by analysing WP versus non-WP post-event feedback.

Methods We delivered three hybrid events to 404 participants (41.34% WP): the Day Programme over 2 days (15–16-year-olds), Week Programme over 2 weeks (16–17-year-olds) and Interview Preparation Events over 3 days (17–18-year-olds). Through lectures, clinical skills and simulation, life during and after medical school was explored.

We conducted anonymised surveys, investigating the usefulness and satisfaction of sessions. Mean Likert scores were calculated, and differences between WP and non-WP responses analysed by Mann–Whitney U tests.

Results Excluding two sessions in the Week Programme and one lecture in the Interview Preparation Event, the Day, Week and Interview Preparation Events had no statistically significant difference between overall or event-specific usefulness and satisfaction between WP and non-WP students. Events were well received by both.

Differences were identified in the Applications session (p-value = 0.0490), Q&A session (p-value = 0.0152) and Scottish University Interview Experience lecture (p-value = 0.0231), rating higher in usefulness and satisfaction for non-WP versus WP.

Conclusion Our data indicate that events were well received by WP and non-WP students, highlighting that our events can reduce the deficit and entry barriers experienced by WP applicants. Further qualitative studies into the specific beneficial aspects for WP participants may help guide future events.

Keywords: medical; prospective; survey; undergraduate; widening participation

Reference

1. McQuillan E, Bailey E, Horsburgh L et al. Differential experiences of prospective medical school applicants from a widening participation background attending the student-led medic insight Glasgow events [version 1; not peer reviewed]. MedEdPublish 2023, 13:100. https://doi.org/10.21955/mep.1115277.1

Louise Harmer, Vicky Almey, Maddie Harper, Jordan Moss, Lisa Mason, Emma Vickers, Amy Perry and Jino Sebastian

George Eliot NHS Trust

A learning objective for final-year medical students in obstetrics and gynaecology is to observe a normal vaginal delivery (NVD). Despite the best efforts of educators and students, students often feel they need more exposure. There is limited research surrounding the use of virtual reality (VR) in this field; research by Sridhar et al. (2023) and Shah et al. (2017) indicates that the use of VR in medical education is promising. A multidisciplinary team research project is being conducted to apply VR principles to medical education. We are using a substream of VR (mixed reality [MR]) using the Hololens technology with a high-fidelity childbirth simulator to provide an innovative learning experience. The Hololens is a MR technology in which elements of a physical and virtual environment are combined through smart glasses. Students are able view the mechanisms of labour via the Hololens while interacting with the simulator allowing the learner to bridge the gap between theory and knowledge through hands-on experience. We are inviting candidates to have a 1:1 MR session following a theoretical taught session. Students are then able to facilitate an NVD under supervision in a psychologically safe environment, with an option to participate in the research. Demographic data will be collected along with pre- and post-session confidence and multiple-choice question (MCQ) scores and general feedback information. Data will be analysed using thematic content analysis for qualitative data and descriptive statistics and t-tests for quantitative data. Six months of preliminary data will be available to present at conference.

Keywords: medical students; mixed reality; normal vaginal birth; simulation; TEL

References

1. Shah, N., Baig, L., Shah, N., Hussain, R., & Aly, S. M. (2017). Simulation based medical education; teaching normal delivery on intermediate fidelity simulator to medical students. J Pak Med Assoc, 67(10), 1476–1481. https://www.researchgate.net/publication/320670778_Simulation_based_medical_education_teaching_normal_delivery_on_intermediate_fidelity_simulator_to_medical_students

2. Sridhar, A., Burrows, J., Nameth, C., & Huang, Y. M. (2023). Real time, remote, and recorded: medical student experiences with smart glasses in obstetrical simulation. South Med J, 116(8), 686–689. https://doi.org/10.14423/SMJ.0000000000001585

Rachel Walters and Christina Thompson

Northumbria Healthcare NHS Foundation Trust

Background Escape rooms have proven to be an incredibly versatile learning tool within medical education. Despite their increasing popularity, their efficacy remains undetermined.¹ This project aims to evaluate whether escape room simulation can enhance communication among medical students and teach skills applicable to real-life practice.

Methods ‘Escape from the Emergency Department’ tasked six final year undergraduate medical students with escaping three rooms each containing a patient presenting with a condition common in emergency medicine: chest pain, a fall and opioid toxicity. Completing a series of knowledge-based problem-solving tasks and communication challenges allowed the students to progress from initial assessment to successful management of each patient, which ultimately resulted in their escape. A debrief where key learning points were discussed followed each room, and qualitative feedback was obtained using questionnaires post-escape room.

Results All students reported that the escape room was both ‘engaging’ and beneficial to their learning and clinical practice. Performing a good SBAR handover and communication tasks, such as managing a patient who wishes to self-discharge, were key learning points highlighted. The debrief component was highlighted as a good opportunity to reflect on practice and to supplement knowledge gained. All students said they would like to take part in further medical escape rooms in the future.

Conclusion An escape room incorporating both technical and non-technical skills increased students' perceived confidence in approaching similar tasks in a clinical environment in the future. Inclusion of communication tasks was deemed to be particularly beneficial.

Keywords: medical education; gamification; undergraduate

Reference

1. Guckian J, Eveson L, May H. The great escape? The rise of the escape room in medical education. Future Healthc J2020;7(2):112–115. https://doi.org/10.7861/fhj.2020-0032

Jordan Rooney, Inga Andrew, Joseph Brayson and Cath Huntley

Northumbria Healthcare NHS Foundation Trust

Escape rooms (ER) are an emerging teaching method, useful in teaching the hidden curriculum, for example, communication, teamwork and leadership.¹ Within the NHS, interprofessional (IP) working is essential for safe and high-quality care.² We designed a pilot to assess the use of an ER to deliver interprofessional education (IPE). We chose antimicrobial stewardship (AMS) as the topic, given its significance and transferability across curriculums.³

Six mini-ERs were created with AMS-focused puzzles/tasks with key learning highlighted through a tutor debrief. Seventy-two learners from undergraduate (medical, pharmacy and nursing) were split into 12 groups, five of which were IP. Groups rotated round each ER. Learners completed a post-session questionnaire.

One hundred per cent of learners felt they could apply this learning in the future. The key learning reported was antibiotic prescribing, for example, adverse drug reactions, appropriate course lengths and intravenous-to-oral switching. Themes from learners' experiences included enjoyable, engaging and high yield, likely to retain learning.

This pilot suggests that ER is an effective method of teaching AMS and the hidden curriculum. IP did not affect speed of puzzle solving/escape, but most learners felt there was benefit to IP learning regardless.

Keywords: antimicrobial; education; escape room; interprofessional; prescribing

References

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

2. Brock D, Abu-Rish E, Chiu C-R, Hammer D, Wilson S, Vorvick L, Blondon K, Schaad D, Liner D, Zierler B Republished: Interprofessional education in team communication: working together to improve patient safety. Postgrad Med J 2013;89(1057):642–651. https://doi.org/10.1136/postgradmedj-2012-000952rep

3. Castro-Sánchez E, Drumright LN, Gharbi M, Farrell S, Holmes AH. Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom. PLoS ONE. 2016;11(2). doi:https://doi.org/10.1371/journal.pone.0150056

Richard Dalton^1,2, Dominic Proctor^1,2, Meghna Rao^1,2, Kunika Kakuta^1,2, William Coppola², John Hines², Stella Ivaz² and Paul Dilworth^1,2

¹Royal Free London NHS Foundation Trust; ²University College London Medical School

Introduction Attendance at learning events in medical student programmes is a source of concern for faculty and students. The limited existing studies primarily explore lecture attendance.^1–3 The aim of this study was to investigate the factors influencing medical students' decision to attend learning activities on clinical placement.

Methods Eleven focus groups with clinical year medical students were conducted at a large UK medical school (n = 50).

Thematic analysis of transcripts was performed (NVivo Software V14.23.2).

Results The data demonstrate substantial heterogeneity in responses. Factors encouraging attendance include the structuring of activities with clear learning outcomes, positive interactivity to consolidate theoretical knowledge, positive pre-conceptions of the quality of tuition among peers and attendance monitoring. Factors discouraging attendance include a desire to undertake self-directed learning for exam preparation, student concerns that attendance at placement may not correlate with assessment performance, travel barriers, repetitive timetabling and cancellations and a lack of ‘structured’ activities such as tutorials and bedside teaching.

Discussion Possible solutions include (1) faculty development to facilitate interactive teaching; (2) reliable provision of timetabled activities with a named departmental contact for timetable changes; (3) simplification of timetables with clustering of activities and avoiding travel for single learning events; (4) exploring interventions to mitigate fatigue; (5) an enhanced role for placement supervisors in student assessment/appraisals; (6) consideration of how placement activities can be more reflected in assessments; and (7) clarification of the travel reimbursement policy.

Application of these principles may improve student experience through efficient allocation of resources to optimise educational outcomes.

Keywords: attendance; absenteeism; clinical placement; engagement; qualitative

References

1. Hoyo LM, Yang CY, Larson AR. Relationship of medical student lecture attendance with course, clerkship, and licensing exam scores. Med Sci Educ. 2020;30(3):1123. Available from: /pmc/articles/PMC8368765/

2. Mitra S, Sarkar P, Bhattacharyya S, Basu R. Absenteeism among undergraduate medical students and its impact on academic performance: a record-based study. J Educ Health Promot. 2022;11(1). Available from: /pmc/articles/PMC9942141/

3. Sharmin T, Azim E, Choudhury S, Kamrun S. Reasons of absenteeism among undergraduate medical students: a review. Anwer Khan Mod Med Coll Journal 2016;8(1):60–66.

Nikki Kerdegari¹, Edelyne Tandanu¹, Karen Lee¹, Rhana Zakri², Pankaj Chandak³ and Prokar Dasgupta⁴

¹King's College London; ²Guy's & St Thomas' NHS Foundation Trust London; ³Transplant Surgery, London Deanery and Research Fellow, London, United Kingdom School of Immunology and Microbial Sciences, KCL, Centre for Stem Cells, Regenerative Medicine and Developmental Biology, Institute of Child Health, UCL; ⁴King's Health Partners

Background Exposure to surgery during medical school is limited (1,2). We ran a mentorship scheme pairing students at a medical school with local surgeons to improve undergraduate insight. We evaluated the effectiveness of mentorship in increasing surgical exposure and drivers for students seeking surgical mentorship.

Methods Thiry-five surgeons across seven specialties were recruited and matched with 37 students in Years 2–4 for 7 months. Quantitative and qualitative evaluation was done with pre-, mid- and post-scheme questionnaires. Students rated confidence across pursuing a career in surgery, surgical exposure, career insight, understanding the application process, contacts, portfolio development, research knowledge and pursuing extracurricular activities related to surgery using a 5-point Likert scale. Paired t-tests were performed to measure students' confidence before and after the scheme.

Results Of students that completed all three questionnaires (n = 21), conducting research/audit was most frequently selected as a main goal (81.0%), followed by theatre experience (66.7%) and career progression support (28.6%). The number of students that had assisted in theatre increased by 50%. There was a statistically significant improvement (p < 0.05) in confidence ratings across all domains. The greatest improvement was seen in understanding of the application process from 2.33 to 3.52 (p = 0.00). 95.2% would recommend the scheme.

Conclusions Students seek mentorship to develop their clinical and academic skills. Students gained significantly more surgical experience and were better equipped with the knowledge required to pursue a surgical career.

Mentorship schemes are invaluable in supplementing the undergraduate curriculum and empowering students.

Keywords: mentor; mentorship; surgery

References

1. Agha RA, Papanikitas A, Baum M, Benjamin IS. The teaching of surgery in the undergraduate curriculum – reforms and results. Int J Surg 2005;3(1):87–92.

2. Agha RA, Papanikitas A, Baum M, Benjamin IS. The teaching of surgery in the undergraduate curriculum. Part II – importance and recommendations for change. Int J Surg 2005;3(2):151–157.

Charlotte Jenkins

Nottingham University

Background Social prescribing is an addition to the holistic care toolkit in primary and secondary care.³ A national scheme is a key component of the universal personalised care plan.² This describes an approach to address mental and physical well-being by connecting people to activities, groups and services within their local area.² While social prescribing is utilised more often, research indicates it is not used to its full potential. Constraints for GPs include lack of formal training on the topic, lack of knowledge regarding local services and time constraints of 10-min consultations.¹

Objectives This project integrated social prescribing into clinical communication training and provided future doctors with tools to utilise social prescribing.

Method A shared decision-making workshop on social prescribing was delivered to second year graduate entry medical students. A Xerte online resource enabled students to pre-read material and case studies. An optional Likert-scale pre- and post-workshop questionnaire was administered. An initial presentation introduced social prescribing and a shared decision-making model. Working in groups, students practised shared decision making around social prescribing with patient actors. An observation guide facilitated detailed, specific feedback.

Results Positive responses were recorded in post-workshop evaluation. Improvements in student understanding encompassed knowledge of social prescribing, identity of health and social care staff, availability of services and confidence in social prescribing through shared decision making.

Conclusions Utilising social prescribing in shared decision making is improved through integration of social prescribing into the curriculum.

Keywords: communication, shared; decision; prescribing; social

References

1. Aughterson H, Baxter L, Fancourt D. Social prescribing for individuals with mental health problems: a qualitative study of barriers and enablers experienced by general practitioners. BMC Fam Pract. 2020;21(1). doi:https://doi.org/10.1186/s12875-020-01264-0

2. NHS England. Social prescribing: Reference guide and technical annex for primary care networks. NHS choices. January 27, 2023. Accessed 31 Dec 2023. https://www.england.nhs.uk/long-read/social-prescribing-reference-guide-and-technical-annex-for-primary-care-networks/.

3. Zisman-Ilani Y, Hayes D, Fancourt D. Promoting social prescribing in psychiatry—using shared decision-making and peer support. JAMA Psychiatry 2023;80(8):759. https://doi.org/10.1001/jamapsychiatry.2023.0788, 760

Jun Jie Lim and Carolyn Staton

School of Medicine and Population Health, The University of Sheffield

An intercalated degree is when a medical student undertakes an extra year to pursue a separate qualification, which brings many benefits well documented in the literature.^1,2 However, the escalating cost-of-living crisis in the United Kingdom, compounded by the recent removal of intercalation degree points by UKFPO, is presumed to be a major factor contributing to a nationwide 40%³ decrease in intercalating students. Within the framework of post-positivism, our study sought to unravel the perceptions and decision-making processes of third-year medical students concerning intercalation.

We distributed a 20-item questionnaire to third-year medical students at Sheffield.

Of the 50 respondents (15% RR), 42% were currently intercalating, 26% were starting their intercalation in the upcoming academic year, and 32% opted not to intercalate. Our results highlighted a significant association between the cost-of-living crisis, removal of points and students' decision to intercalate (p < 0.001, p = 0.047, respectively). Notably, 81% of students opting not to intercalate were influenced by the cost-of-living crisis compared to 19% of currently intercalating students, emphasising a potential inequality in intercalation opportunities. Content analysis of the open responses identified several key quotes such as ‘cost-of-living crisis made intercalation even more unaffordable’, ‘NHS bursary insufficient to cover my rent’ and ‘cannot afford another year at university’.

Our study establishes a significant correlation between the cost-of-living crisis, the removal of points and the decision to intercalate, with intercalating students less affected by the economic challenges. These findings suggest an inherent inequality in the accessibility of intercalation opportunities, prompting further examination and potential interventions.

Keywords: cost-of-living crisis; intercalation; medical student; survey; undergraduate

References

1. Sorial, A.K., Harrison-Holland, M. & Young, H.S. The impact of research intercalation during medical school on post-graduate career progression. BMC Med Educ 21, 39 (2021). https://doi.org/10.1186/s12909-020-02478-7

2. Graham, B., Elbeltagi, H., Nelmes, P., Jenkin A., Smith J.E. What difference can a year make? Findings from a survey exploring student, alumni and supervisor experiences of an intercalated degree in emergency care. BMC Med Educ 19, 188 (2019). https://doi.org/10.1186/s12909-019-1579-x

3. Staton, personal correspondence.

Ian Hunt and Phoebe Brobbey

University Hospitals Coventry and Warwickshire NHS Trust

Background Medical students often feel ill-equipped to lead emergency scenarios.¹ Some of this may be attributed to unfamiliarity with non-technical skills² and lack of confidence.

Method Adapting existing case presentations during simulation for medical students, we designed two alternative ways to encourage hands-off leadership and closed-loop communication—the first placed the leader in a separate room, able only to communicate with their team audio and visual equipment. The second placed the leader in a demarcated ‘box’ on the floor within the simulation room where they could communicate freely but could not leave the ‘box’.

Students in each group were then surveyed anonymously.

Results The first group all agreed the importance of hands-off leadership being highlighted; however, only two out of five students thought this would change their future practice. One student thought it was confusing, and two students thought it would work better with the leader within the room but unable to be ‘hands-on’.

The second group also had the benefits of emphasising ‘hands-off’ leadership and closed-loop communication. However, there were no negative comments about the logistics, and it was far less resource and time intensive. Four out of five students in this group felt they would change their future practice as a result.

Conclusion Encouraging a hands-off approach to leadership in a psychologically safe space empowers students to lead without becoming task focused. Evaluating the impact of the method on the confidence of the students in their leadership skills could be another avenue for research.

Keywords: communication; leadership; medical; non-technical; simulation

References

1. Moretti K, Aluisio AR, Gallo Marin B, Chen CJJ, González Marqués C, Beaudoin FL, Clark M, Patiño A, Carranza H, Duarte A, Moreno A, Aguiar LG, Arbelaez C Confidence and knowledge in emergency management among medical students across Colombia: a role for the WHO basic emergency care course. PLoS ONE. 2022;17(1):e0262282. https://doi.org/10.1371/journal.pone.0262282

2. Cha JS, Anton NE, Mizota T, Hennings JM, Rendina MA, Stanton-Maxey K, Ritter HE, Stefanidis D, Yu D Use of non-technical skills can predict medical student performance in acute care simulated scenarios. Am J Surg 2019;217(2):323–328. https://doi.org/10.1016/j.amjsurg.2018.09.028

Cat Buechel, Aishah Anas and Lalit Mishra

Nottingham University Hospitals

Background Our population is ageing, with 18.6% of the population in England and Wales now aged over 65, including half a million aged 90 or older.¹ This means that student doctors are likely to spend more time caring for older patients throughout their careers but may not feel sufficiently prepared to do so. Simulation can offer a method of allowing students to hone their skills of managing older patients in an educationally safe environment to prepare them for their futures.

Aim To improve students' knowledge and confidence in approaching challenging but common scenarios in the care of older people.

Methods A four-station circuit was created to simulate a ‘real-life’ frailty clinic, covering falls and incontinence history-taking, discussion of DNACPR and polypharmacy management. Simulated patients were used for three out of four stations. Ninety-four students attended over 3 months and were asked to complete a pre- and post-session questionnaire. The questionnaire included eight multiple-choice knowledge questions and confidence rating on a 4-point Likert scale.

Results Eighty-eight students completed the pre-session, while 86 completed the post-session questionnaire. Questions focused on students' knowledge demonstrated an average of a 26.5% increase in correct answer selection following the session.

Students' confidence demonstrated a significant increase. An average of 35.7% of students reported they were confident or very confident prior to the session, while 96.2% of students reported they were confident or very confident after the session.

Conclusion Participating in a simulated frailty clinic increased students' knowledge and confidence in caring for older people.

Keywords: communication; frailty; simulation; undergraduate

Reference

1. Office for National Statistics (ONS). Released 2 November 2022, ONS website, statistical bulletin. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/populationandhouseholdestimatesenglandandwales/census2021unroundeddata

Andrea Wilkinson¹, Colin Macdougall², Louise Harmer¹ and Michele Gutteridge²

¹George Eliot Hospital; ²Warwick Medical School

Introduction The use of virtual reality (VR) in medical education is increasing, but there is very little implemented in the area of palliative medicine, and it is unclear whether this is an effective method of teaching palliative care skills. A service evaluation was conducted into the role of a palliative VR learning platform.

Methods A 360-degree VR was created for medical students with a focus on communication with a dying patient. Second-year medical students were invited to participate. Confidence scores and short answer questions were given to the students either prior to the VR (control group) or after the VR (experimental group), and their feedback was collected.

Results Ninety-seven students were enrolled with 47 participants in the control group and 50 in the experimental group. All five parameters for confidence levels were statistically significant to the p < 0.001 level. Two out of four of the marked short answer questions (SAQs) were statistically significant, one was almost significant, and one was not significant. Participants also provided feedback, and two interviews were conducted for thematic analysis with 75% of participants stating the VR was ‘good or excellent’.

Discussion Confidence scores, SAQs, feedback and interviews were all reviewed and collectively indicate the efficacy of the VR being an effective and acceptable way to teach palliative medicine. The study design was robust, but alternative methods of assessment may have been more appropriate for palliative communication.

Conclusion The VR was effective in improving confidence and knowledge, and it was well received by the medical students.

Keywords: curriculum; medical students; palliative; simulation; virtual reality

References

1. Lege, R., & Bonner, E. (2020). Virtual reality in education: the promise, progress, and challenge. Jalt Call Journal, 16(3), 167–180.

2. Randall, D., Garbutt, D and Barnard, M (2017) Using simulation as a learning experience in clinical teams to learn about palliative and end-of-life care: a literature review J Death Stud Vol 42, Issue 3.

3. Zhao, J., Xu, X., Jiang, H., & Ding, Y. (2020). The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies. BMC Med Educ, 20(1), 1–10.

Joanne Ridgley-Vaidya, Nathan Walker, Timothy Davies, Umarah Muhammad, Sara Mahmood and Madhan Krishnan

Alder Hey Children's Hospital

Background The advent of augmented reality (AR) presents many potential benefits in medical education. One such benefit for undergraduates is access to clinical teaching due to student numbers and limited clinical exposure. This project aimed to establish the utility of AR in bedside teaching for medical students undertaking a paediatric ENT rotation.

Methods A multi-group teaching programme was run for fourth year medical student undertaking a week-long paediatric ENT rotation. A student volunteer, accompanied by a registrar, wore a Microsoft HoloLens and attended the bedside of a paediatric ENT inpatient to perform a history and examination. The clinical encounter was streamed through Microsoft Teams to a lecture theatre where the remainder of the students were able to watch, interact and ask questions. A self-designed feedback questionnaire was then completed.

Results Seventy-eight students completed feedback. 88.6% (n = 69) had not previously used AR. 97.4% (n = 76) agreed or strongly agreed they found the session interesting. 91.0% (n = 71) agreed or strongly agreed they found the session useful for learning. 89.7% (n = 70) agreed or strongly agreed they would like to attend another session. 60% (n = 3) disagreed or strongly disagreed AR was as useful as traditional bedside teaching. Issues addressed in qualitative feedback were that of internet connection and familiarity of students with the equipment.

Conclusion Augmented reality can facilitate increased clinical exposure, with utility in specialties with low inpatient numbers and sensitive patient populations (such as paediatrics). Overcoming limitations including inexperience with the headset are crucial to bringing utility in line with traditional bedside teaching.

Keywords: augmented reality; bedside teaching; undergraduate

Nikki Kerdegari¹, Deevyesh Sunder Bala Sundaram², Roger Kirby³ and Gillian Leng³

¹King's College London; ²Barts and The London School of Medicine and Dentistry; ³The Royal Society of Medicine

Background Medical students have limited exposure to what the future of medicine and surgery will look like. The Tomorrow's Doctors 2023 conference aimed to improve students' understanding of current medical and surgical innovations. The aim of this study was to determine the impact of attending workshops and using virtual reality on students' perception of healthcare innovations.

Methods Students were exposed to healthcare innovations through workshops on virtual reality, laparoscopic simulation, microsurgery, fracture fixation, angiography and ultrasonography. Delegates rated the importance of the adoption of each skill before and after using 5-point Likert scales via questionnaires. Pre- and post-conference ratings were analysed using descriptive statistics.

Results Days 1 and 2 were attended by 90 and 85 delegates, respectively, from 16 medical schools. Seventy-one (40.6%) delegates completed the pre-conference questionnaire. Post-conference questionnaires were completed by 45 (50.0%) and 42 (49.4%) delegates for days 1 and 2, respectively. 82.2% and 83.3% of days 1 and 2 respondents reported that the conference engaged their interest in pursuing surgical or medical innovation.

Mean importance ratings improved from pre- to post-workshop for each workshop with the greatest improvement seen in the laparoscopic simulation workshop (3.52 ± 1.35 versus 4.05 ± 1.06), followed by angiography (3.38 ± 1.38 versus 3.90 ± 1.03) and fracture fixation (3.50 ± 1.37 versus 3.90 ± 1.03).

Conclusions Conference workshops are an effective teaching modality for improving medical students' understanding of both the importance and appreciation of healthcare innovations. Future student conferences should run such workshops, enhancing students' appreciation of healthcare innovations.

Keywords: conference; innovation; surgery; workshop

Jun Jie Lim¹, Jack Wellington², Robert Bain³, Wei Ying Chua⁴, Ankit Gupta², Elisha De-Alker⁴, Jane Yi Jen Poh⁵, Ruby O'Loughlin² and Chin Ning Liu⁴

¹School of Medicine and Population Health, The University Of Sheffield; ²University of Leeds; ³Newcastle University; ⁴Hull-York Medical School; ⁵University of Sheffield

The Specialised Foundation Programme (SFP) is a highly competitive strand of the foundation programme that provides protected time for doctors to develop research, medical education and leadership skills alongside clinical practice. Concerns have been raised regarding access to preparatory resources by applicants and key stakeholders. We aimed to improve accessibility of the SFP for all and offer guidance on the application process through a series of online webinars and workshops.

‘SFP Unlocked: Keys to Clinical Academia’, founded by SFP doctors, was established to support applicants, through bi-weekly online sessions over August–November 2023. SFP doctors facilitated sessions, alongside regional SFP directors. Pre- and post-session feedback surveys were disseminated to attendees.

‘SFP Unlocked’ had 332 medical student attendees from >20 institutions globally. Session recordings accumulated 600 views, surmounting >10,000 min viewed. Feedback gathered among 179 responses (54% response rate) were obtained. Knowledge regarding the application process significantly increased over sessions (pre-session median 3/5 [IQR: 2–4]; post-session median 4/5 [IQR: 4–5]; p < 0.001). Additionally, students found the sessions highly engaging (median 5/5 [IQR:4–5]); session format received positive feedback (median 5/5 [IQR: 4–5]). Content analysis revealed that participants appreciated the informative content, practical examples, personal insights and valuable preparation for SFP applications.

The ‘SFP Unlocked’ series was a nationally organised initiative that aided a wide range of students prepare for the SFP application internationally. Our programme incorporated SFP directors and SFP doctors to provide a wide range of insights into the SFP. Our presentation will focus on the learning points of working as part of a national collaboration.

Keywords: clinical academia; medical students; national teaching series; peer teaching; Specialised Foundation Programme (SFP)

Maria Karadimova-Watts¹ and Niki Jakeways²

¹GKT School of Medical Education, King's College London; ²King's Undergraduate Medical Education in the Community (KUMEC), King's College London

Background Medical students' diet can contribute to both academic and professional performance: A balanced diet (such as the Mediterranean diet) is associated with higher academic performance¹; and balanced diet education, through culinary medicine classes, can lead to improved confidence and readiness for dietary counselling.² Barriers to achieving a balanced diet have been studied in the general population, but little is known about the experience of medical students, particularly in their final years when undertaking clinical placements and after a prolonged period of study. How we might help support medical students to achieve a balanced diet thus represents an important area where help might be targeted to aid students in achieving their maximum potential. Therefore, this study aims (i) to explore the perceived barriers and enablers to achieving a balanced diet faced by fourth and fifth year clinically placed medical students and (ii) to explore student ideas of how these barriers can be reduced.

Methods Semi-structured interviews with fourth and fifth year medical students at King's College London will be conducted, focusing on perceived dietary barriers, enablers and methods to reduce these. The data generated will be analysed using Braun and Clarke's six phases of thematic analysis.³

Results Study findings will aim to both reflect dietary barriers faced by medical students and suggest support strategies to overcome them.

Conclusion There is potential for the study findings to (i) elucidate this topic and (ii) to inspire change and improve dietary support available for medical students.

Keywords: barriers; diet; enablers; medical; student

References

1. Antonopoulou M, Mantzorou M, Serdari A, Bonotis K., Vasios G., Pavlidou E., Trifonos C., Vadikolias K., Petridis D., Giaginis C. Evaluating Mediterranean diet adherence in university student populations: does this dietary pattern affect students' academic performance and mental health? Int J Health Plann Manag 2020;35(1):5–21. https://doi.org/10.1002/hpm.2881

2. Wood NI, Gleit RD, Levine DL. Culinary nutrition course equips future physicians to educate patients on a healthy diet: an interventional pilot study. BMC Med Educ 2021;21(1):280. https://doi.org/10.1186/s12909-021-02702-y

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

Nicholas Fisher and Matthew Simmons

Queen Mary University of London

In 2023, the Faculty of Medicine and Dentistry at Queen Mary University of London launched a blended learning graduate-entry medical degree, partly funded by NHS England. This project is at the cutting edge of medical education, the first of its kind in the United Kingdom. Drivers for the programme include shortages in healthcare staff in the NHS¹ and an NHS commitment to widen access to healthcare education and promote diversity and inclusion.² Numbers of medical school places will be expanded yearly, and blended learning can increase student numbers from those communities that might have difficulty accessing medical education. In addition, NHS England has identified that blended learning can potentially improve learning outcomes and student engagement and promote the growth of a digitally literate workforce.³

The blended learning course has been a bespoke construction based on lessons learned during COVID and good practice in digital learning. Programme participants study 1 day a week purely from home, in which they are timetabled to work on a series of high-quality asynchronous resources, which feed into the rest of the learning week. The course utilises a range of multimedia to create an interactive experience, and weekly videos from module lead to connect students to the course.

The presentation will include examples of the interactive in the blended learning programme, student feedback on their experiences gained from questionnaires and focus groups and lessons that have been learned by the Learning Innovation Team at QMUL, who designed the learning content.

Keywords: degree; blended; inclusion; medical; programme

References

1. Waitzman E. Staff shortages in the NHS and social care sectors. House of Lords Library. Published 9 December 2022. Accessed 19 Jan 2024. https://lordslibrary.parliament.uk/staff-shortages-in-the-nhs-and-social-care-sectors/

2. NHS Health Education England. Widening participation. It matters! Our strategy and initial education plan. Published October 2014. Accessed 10 Jan 2024. https://www.hee.nhs.uk/sites/default/files/documents/Widening%20Participation%20it%20Matters_0.pdf

3. NHS Health Education England. Blended learning for pre-registration and undergraduate healthcare professional education. Published January 2022. Accessed 10 Jan 2024. https://www.hee.nhs.uk/sites/default/files/documents/220405_Blended%20Learning%20Guidance%20Report_FINAL.pdf

Elizabeth Liew¹, Arya Vikas¹, Aparna Thomas¹, Kabir Josan², Abhinav Deshwal² and Grazia Vigo¹

¹Nottingham University Hospital NHS Trust; ²University of Nottingham Medical School

Background In response to the disruptions caused by COVID-19 and the political situation in Myanmar, the Myanmar Health Education Support Group (HESG) initiated the Medical Educators Development Program for educators who found themselves without formal training opportunities. Currently, the program consists of three modules delivered remotely by healthcare professionals from Myanmar and other global organisations, covering professional knowledge, skills and values.

Methods Sixty-eight participants underwent evaluation through attendance, coursework completion, the submission of online portfolios and the use of Kirkpatrick's evaluation levels,¹ with Level 1 evaluations conducted through questionnaires and Level 2 through reflective portfolios. Notably, the ongoing project has progressed beyond Levels 1 and 2 and currently extends to Level 3.

Results Analysis of reflection portfolios and questionnaires reveals a substantial positive impact on their professional identity and skills, demonstrating Levels 1 and 2. The feedback collected through questionnaires continues to demonstrate a high level of satisfaction. Evidence of Level 3 learning is widely reported; through experiential learning and facilitated group activities, educators have actively applied the program's teachings in clinical teaching sessions. The formation of communities of practice among educators is a testament to the program's success in fostering impactful learning environments.

Conclusion The program has received accreditation from the Academy of Medical Educators and the Royal College of Surgeons (Edin), providing professional recognition on an international level and ensuring the continued professional development of participants. These results contribute to the ongoing improvement of medical education in Myanmar and offer valuable insights for similar contexts worldwide.

Keywords: education; innovation; Post-Covid; reflection; virtual learning

Reference

1. Smidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: a useful tool for evaluating training outcomes. J Intellect Develop Disabil 2009;34(3):266–274. https://doi.org/10.1080/13668250903093125.

Charlotte Parvin and Ifunanya Ikhile

University of Nottingham

Background OSCE examiner training methods that are central to accurate and consistent marking in OSCEs and essential for exam reliability (1) are often not described nor reported in sufficient detail in literature, hence this scoping study.

Aims To establish evidence-informed OSCE examiner training methods in UK medical education while identifying and discussing their merits and challenges towards a best practice approach.

Method A scoping review was carried out applying the JBI review framework (2). PubMed, Web of Science (WOS) and the Education Resources Information Centre (ERIC) were searched for papers published between 2003 and 2023 in the UK applying curated inclusion criteria. Titles, abstracts and full texts were screened.

Analysis The six-step thematic analysis method described by Braun and Clarke was used (3). Descriptions of examiner training methods were codified and thematised.

Results This review highlighted a research/reporting gap in OSCE examiner training methods. Five papers were included in the final analysis with limited descriptions of examiner training methods. Training methods types identified (online and face-to-face) were generic, processes non-descript, and their merits and challenges such as time requirements and nuance loss discussed non-specifically; however, a potentially useful three-stage training structure was established: clarification of examiners' role, practical teaching, and discussion/calibration. Most training videos used only showed excellent and failure performances, neglecting the borderline.

Conclusions Further research into more specific training types and process with clear descriptions of techniques that involve the use of borderline performance videos will be useful to establish best practice approaches that are reliable yet feasible.

Keywords: challenges; examiner; merits; OSCE; training

References

1. Mahmoud A. A comparison of checklist and domain-based ratings in the assessment of objective structured clinical examination (OSCE) performance. Cureus 2023;15(6):e40220.

2. Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth 2020;18(10):2119–2126.

3. Braun V. Using thematic analysis in psychology. Qual Res Psychol 2006.

Catharine Lumb and Timon Blakemore Kocadag

Leeds Teaching Hospitals Trust

Background Transition to clinical medicine challenges medical students' confidence and academic direction.¹ Foundation doctors play a significant role in ward-based training; however, with frequent rotation of doctors and students, continuity is limited. Near-peer mentoring schemes increase student confidence and skills, providing role models at similar stages in career development.² We demonstrate that a university-wide mentoring scheme for third year students eases transition and is feasible at a large teaching hospital trust.

Methods Foundation Year 1 mentors and third year medical students were recruited through a Google form distributed via university and foundation school administration. Students were allocated to pairs of doctors with a median student group size of seven for an academic year.

Results Fifty-two mentors (49% uptake) and 171 students (60%) were recruited. Fifteen students (8.8%) indicated a preference for specific mentor characteristics or specialty. Students from nine of the 26 groups provided final feedback.

Themes from feedback were desire for positive role models, anxiety surrounding clinical experience, need for career guidance and concern over frequent rotation.

Discussion The high uptake demonstrates demand for programmes connecting students and doctors. With studies demonstrating no difference in student skill levels when taught by peers compared to experts,³ the advantage of mentors who understand students' academic and professional requirements is clear. Key themes highlight student benefit from educational and career support, with a consistent learning environment. Logistical challenges of cross-site organisation limited accessibility. The scheme, now in its second iteration, will collect further results this year to supplement current limited engagement with feedback.

Keywords: continuity; mentoring; near-peer

References

1. Atherley A, Dolmans D, Hu W, Hegazi I, Alexander S, Teunissen PW. Beyond the struggles: a scoping review on the transition to undergraduate clinical training. Med Educ 2019;53(6):559–570.

2. Yap AF, Ruan X, Fong WWS. Development of a pPersonalized near-peer mentoring programme for final-year medical students with residents as mentors. Proc Singap Healthc 2022;31.

3. Khapre M, Deol R, Sharma A, Badyal D. Near-peer tutor: a solution for quality medical education in faculty constraint setting. Cureus 2021;13(7):e16416.

Isobel Francis¹, Akshaya Mathialagan², Yoke Sin Hoh¹ and Edward Mawdsley¹

¹North Middlesex University Hospital; ²Middlesex University Hospital

Background Literature reviews have identified that medical graduates remain unprepared and apprehensive when dealing with acute emergencies due to lack of real-life acute care exposure during undergraduate training.^1–3

Responding to the need to better prepare graduates for practice, we have introduced the novel ‘Student Cardiac Arrest Bleep’ (SCAB) initiative.

Methods Basic Life Support (BLS)-certified final year medical students were assigned a cardiac arrest bleep alerting them to attend emergencies during their ‘Student Assistantship’ placement. Students were informed of SCAB's learning objectives and their roles. Post-event debrief facilitates students' understanding of their actions through reflection, promotes learning outcomes and enhances future clinical performance.

Students' perceived confidence before and after SCAB initiative were evaluated using questionnaires based on a 5-point Likert scale.

Results Nineteen final year medical students took part in the SCAB scheme. All students completed the pre-SCAB questionnaire, but only 10 students (53%) submitted their post-SCAB evaluations. Prior to SCAB, most students (95%; n = 18) are found to be not confident in attending arrest calls with the majority (n = 13) expressing an extreme lack of confidence.

Following SCAB, students' perceived confidence has improved significantly. Eighty per cent (n = 8) of participants who completed the post-SCAB questionnaire expressed increased confidence in responding to emergencies and understanding of a newly qualified doctor's role in cardiac arrest encounters.

Conclusion Our findings suggest that hands-on experience, guided reflection and actual multidisciplinary team working experiences can improve their confidence and preparedness in dealing with acute emergencies. SCAB can inspire the development of future undergraduate educational interventions.

Keywords: education; emergencies; medical; reflection; undergraduate

References

1. Fung CY, Kearney L, Hatfield E, Martin NM, Halse O, Jensen-Martin J, Hughes E, Sam AH Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals. BMJ Open 2022;12(12):e061842. https://doi.org/10.1136/bmjopen-2022-061842

2. Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors' first day at work. PLoS ONE 2009;4(9):e7103. https://doi.org/10.1371/journal.pone.0007103

3. Tallentire VR, Smith SE, Skinner J, Cameron HS. Understanding the behaviour of newly qualified doctors in acute care contexts. Med Educ 2011;45(10):995–1005. https://doi.org/10.1111/j.1365-2923.2011.04024.x

Nathan Betteridge and Nicola Cooper

University of Nottingham

Background Clinical leadership has witnessed rapid expansion in both research and training, while medical education leadership has not. In light of current healthcare challenges post pandemic, the pressure to educate medical professionals quicker, smarter and more effectively is significant,¹ and viewing medical education (MedEd) leadership solely through the lens of clinical leadership misses its unique challenges.² Current literature gives understanding of leadership identity but is incomplete.

Aims To explore how clinicians in postgraduate MedEd leadership conceptualise and think about their practice.

Methods Seven semi-structured interviews were conducted in the North West England postgraduate deanery. Transcript data were analysed and constructed into themes and categories in line with a qualitative phenomenographic methodology.

Results Five categories of description emerged from the grouped themes and arranged into a hierarchical outcome space. Postgraduate MedEd leaders initially conceptualise their practice as a collaborator (Category A1) and manager (Category A2) of training. These categories inform their conceptualisation as a decision maker (Category B) to impact and fulfil their role as overseer (Category C) of education governance and standards. Advocacy (Category D) was foundational to all these running as a thread, yet still standing as a distinct conceptualisation of enacting fairness and support in education.

Discussion A unique feature of this research is the relational description and interaction between each of these categories. It highlights areas beyond leadership identity not previously described and emphasises the fundamental importance of leaders conceptualising their role in delivering fairness and support. This research will allow further understanding how to train and educate leaders in each category.

Keywords: education; leadership; medical; postgraduate; research

References

1. British Medical Association (BMA). Medical staffing in England: a defining moment for doctors and patients. London; 2021. Accessed 15 May 2023. https://www.bma.org.uk/media/4316/bma-medical-staffing-report-in-england-july-2021.pdf

2. Van Diggele C, Burgess A, Roberts C, & Mellis C. Leadership in healthcare education. BMC Med Educ 2020;20:456.

Francis Screech¹, Lucy Obolensky², Beth Norman³, Jonathan Milton⁴ and Imara Gluning⁵

¹University Hospitals Plymouth; ²University of Plymouth; ³Yeovil District Hospital; ⁴Royal Cornwall Hospital Trust; ⁵Brighton NHS Trust

Improving doctors' well-being has become a concern for the NHS due to its correlation with patient outcomes, satisfaction and medical workforce retention.¹ Following the COVID-19 pandemic, there was a discernible decline in medical staff well-being.² In an aim to address this, we developed a 2-day course.

The course aimed to improve well-being through small group workshops in scenic locations, incorporating team building and expedition medicine skills. Resilience and mental health discussions complemented the workshops.

Over a 3-year period, doctors from south-west England participated in the programme at remote coastal or moorland locations. The experienced team facilitated outdoor workshops, for example, building improvised shelters. These sessions served to break down barriers and foster connections, such that participants felt comfortable to ‘open up’ during the mental health and resilience sessions. Group cohesion was further bolstered with outdoor activities like yoga, wild swimming or hiking.

To evaluate the long-term effectiveness of this course, all delegates received a semi-structured questionnaire consisting of 10 questions using a Likert scale. A response rate of 70 out of 310 delegates was attained. 97.1% perceived the course valuable, with 79.1% reporting an enhanced sense of ‘team’ and 75% feeling better equipped to handle work stress. 98% of delegates reported wanting to re-attend in the future with 81.9% stating that their organisation did not offer any similar courses.

The study concludes that the ‘Remote and Restorative’ course had a sustained positive impact, suggesting its value to delegates. Therefore, extending such courses to the wider multidisciplinary team may be valuable.

Keywords: innovation; resilience, expedition; outdoors; well-being

References

1. NHS staff management and health service quality [Internet]. GOV.UK. 2019. Available from: https://www.gov.uk/government/news/nhs-staff- managementand-health-service-quality

2. West C. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294. Available from: https://jamanetwork.com/journals/jama/article-abstract/184625.

Caroline Groves, Anton Saayman, Kaye Walters and Jane Gwilliam

Health Education and Improvement Wales

HEIW introduced the ‘Trainees Transforming Training’ (TTT) initiative, providing trainees with opportunity to develop innovative projects to improve experience, training and patient care.

NHS challenges post-pandemic, national survey findings on educational environment quality and ‘Future Doctor’¹ recommendations, are driving development of experiences for medical and other healthcare professionals focused on training and working within transformed multiprofessional teams to deliver high-quality healthcare.

Postgraduate medical trainees were invited to apply for financial support for projects (maximum funding £3000) aligned to HEIW priorities to embed multiprofessional, collaborative approaches to education, training and working.

A HEIW panel double scored applications against objective, weighted criteria: originality/innovativeness; TTT objective congruence; cost-effectiveness and return on investment; impact/potential for adoption nationally; sustainability and potential for effective implementation.

Forty-six projects from a broad cross section of trainees in Wales secured funding. Encompassing multidisciplinary training courses, interdisciplinary fora, cross-specialty procedure training and simulation-based education, projects either have potential for generalisation nationally or will impact trainees at national level.

Many projects focused on harnessing new technologies (VR, 3D printing) in teaching or support for trainee well-being including ‘return to training’. Sharing of educational resources and broadening training access to groups including AHPs and PAs was noted.

Potential benefits include skillset sharing across professional groups, increased training resource accessibility and exposure to learning opportunities, maximisation of learning experiences, positive impacts on service delivery and trainee engagement in future improvement work.

HEIW is conducting interim reviews of project progress to evaluate benefits to training and identify good practice for presentation at ASM 2024.

Keywords: innovation; medical; multiprofessional; postgraduate; training

Reference

1. Health Education England. The future doctor programme: a co-created vision for the future clinical team. Published 2 September 2020. Accessed 24 Jan 2024. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Future%20Doctor%20Co-Created%20Vision%20-%20FINAL%20%28typo%20corrected%29.pdf

Beatrix Tan, Gary Campbell and Joanne Sloan

University of Dundee

Background Prescribing intravenous fluids is an important skill carried out by approximately 90% of Foundation Year 1 doctors.¹ Unfortunately, current prescribers struggle to meet the current National Institute of Health and Care Excellence (NICE) 2013 guidelines and are contributing to the morbidity and mortality of patients.²

Methods An initial survey conducted among the final year medical students at the University of Dundee revealed that only 27% felt prepared to conduct a fluid review for a patient with only 13% feeling able to prescribe intravenous fluids.

Therefore, to empower the students to prescribe intravenous fluids safely, a workshop has been designed based on the Goldilocks principle: ‘just the right amount of fluid’.

A literature search was undertaken with regard to current educational interventions surrounding intravenous fluid prescriptions. They range from lectures, online modules, ward-based teaching to flash or lanyard cards and pocket guides. Simulation-based education will enable students to assess a simulated patient and prescribe intravenous fluids in a safe and controlled environment. The students will be able to obtain real-time feedback via a REALITi 360 vital signs monitor, the simulated patient and subsequent peer and facilitator feedback during the debrief.

Results This workshop will be piloted in March 2024 and aims to address the gap between theory and practice.³ A further evaluation will be carried out post-pilot to assess effectiveness of the workshop in improving confidence and skill in prescribing intravenous fluids.

Keywords: education; fluids; medical; prescribing; simulation

References

1. Lim CT, Dunlop M, Lim CS. Intravenous fluid prescribing practices by foundation year one doctors – a questionnaire study. JRSM Short Rep 2012;3(9):1–7. https://doi.org/10.1258/shorts.20121.012041

2. Forryan J, Mishra V. Optimisation of intravenous fluid prescribing: framework for changing practice through education and audits. BMJ Open Qual. 2017;6(2):e000187. https://doi.org/10.1136/bmjoq-2017-000187

3. Weller JM. Simulation in undergraduate medical education: bridging the gap between theory and practice. Med Educ 2004;38(1):32–38. https://doi.org/10.1111/j.1365-2923.2004.01739.x

Lakshminarayanan Varadhan, Ruth Kinston, Matthew Webb, Peter Coventry and Biju Jose

Keele University

Background Prescribing is an essential skill in medical practice and encompasses several clinical competencies. A structured, multifaceted teaching programme needs to be integrated into medical curriculum to achieve this competence.¹

Conclusion A multifaceted approach to teaching prescribing through small group workshops, entrusted professional activities and focused curriculum changes can help to enhance learning and preparedness for clinical practice.

Keywords: clinical preparedness; prescribing; therapeutics

References

1. https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices

2. Kinston R, McCarville N, Hassell A. 2019. The role of purple pens in learning to prescribe. Clin Teach 16(6):598–603. https://doi.org/10.1111/tct.12991

3. https://edt.gmc-uk.org/progression-reports/f1-preparedness

Constance Wraith, Elizabeth Morgan, Cate Goldwater Breheny, Eve O'Connell and Rasha Mezher-Sikafi

Imperial College London

Professional identity formation (PIF) is an integral part of medical student development.^[1] Educators are tasked with nurturing students on their transformational journey to thinking, acting and feeling like a doctor as they approach their final exams. Traditionally, our institution teaches topics such as reflection, resilience and moral distress as in-person small group teaching and interactive lectures. However, this has often been restricted to the early years where students are based on campus. Indeed, access to students for centralised teaching in their later clinical years has been challenging due to their time spent on placements.

With the move to online learning over the COVID-19 pandemic,^[2] educators were faced with the dilemma of urgently creating online resources to support students learning. As a consequence of this, many institutions trialled teaching PIF using digitally enhanced learning technologies.^[3] While most teaching has now reverted to pre-pandemic methods; we have highlighted the potential use of digital learning tools to enhance the PIF curriculum in the later clinical years.

Three asynchronous interactive learning events have been developed targeting key PIF learning areas of developing resilience, reflection and understanding moral distress. These topics spiral through the longitudinal PIF curriculum and were designed in collaboration with student partners. Innovative, interactive tasks are nestled between informative contents that provide a set of virtual learning tools targeting students in the latter stages of their course, with the aim that the flexibility of these online learning events will give students autonomy over their PIF journey.

Keywords: asynchronous; digital; identity; professional

References

1. Wald HS. Professional identity (trans) formation in medical education: reflection, relationship, resilience. Acad Med 2015;90(6):701–706.

2. Papapanou M, Routsi E, Tsamakis K, Fotis L, Marinos G, Lidoriki I, Karamanou M, Papaioannou TG, Tsiptsios D, Smyrnis N, Rizos E. Medical education challenges and innovations during COVID-19 pandemic. Postgrad Med J 2022;98(1159):321–327.

3. Liang JZ, Ng DK, Raveendran V, Teo MY, Quah EL, Chua KZ, Lua JK, Owyong JL, Vijayan AV, Abdul Hamid NA, Yeoh TT. The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: a systematic scoping review. PLoS ONE 2024;19(1):e0296367.

Antonia Peilober-Richardson and Jack Atherton

Background Anecdotally, the distribution of unendorsed ‘question banks’ and resources for assessments is commonplace among UK undergraduate medical students. The nature of such unregulated and controversial behaviours makes ascertaining their true prevalence challenging, and whether this should truly be defined as academic misconduct is heavily debated.¹

Purpose To review the current literature surrounding prevalence and perception of such examples of academic misconduct; explore perceptions among recent UK medical graduates; measure self-reported prevalence in this cohort; and identify categories of students at risk of discrimination.

Methods Literature review exploring the prevalence and perceptions of academic misconduct, particularly the distribution of historic examination material.

Mixed-methods questionnaire, with an inclusion criteria of current UK foundation trainees having graduated from a UK medical school. Themes included perceptions and self-reported behaviours related to unendorsed assessment materials and trends in academic and socio-economic domains.

Results Only eight studies met the inclusion criteria: three since 2013 and two UK-based, highlighting paucity of research in this area. The most relevant was a 2001 novel questionnaire at a single Scottish medical school.²

Study currently open to current foundation trainees as per inclusion criteria, with final results in March 2024. Early qualitative analysis of data reveals key findings including higher prevalence than previously reported with 90.5% discussing details of assessments and 71.4% being in possession of question banks and significant disputation about personal, medical school and General Medical Council perceptions. Thematic analysis demonstrates access to these resources is inequitable and discriminatory against certain groups, for example, international students and students outside certain social circles.

Keywords: cheating; honesty; misconduct; probity; professionalism

References

1. Billingsley M, Elliott L. What counts as cheating during medical school exams? BMJ. 2017:j2863. https://doi.org/10.1136/sbmj.j2863, 358

2. Rennie S, Crosby J. Are “tomorrow's doctors” honest? Questionnaire study exploring medical students' attitudes and reported behaviour on academic misconduct. BMJ 2001;322(7281):274–275. https://doi.org/10.1136/bmj.322.7281.274

Andrew Wilson¹ and Laura Knight²

¹University College London; ²Imperial College London

Background The neoliberalisation of society involves, in part, the de-legitimisation of traditional professionals and the production of neoliberal elites.¹ Until recently, healthcare professionals maintained professional status in neoliberal societies via their expert-knowledge. Following several high-profile scandals, and with a growing concern for ‘patient safety’ and ‘risk’, the profession (and arguably its professional status) became the target of policy reform. Reforms require an individual's ‘professionalism’ to be demonstrated, assessed and regulated. But what is ‘medical professionalism’, and how can demonstrating/assessing/regulating it improve patient safety?

Methods Using Hyatt's critical higher education policy discourse analysis framework² and Foucauldian notions of governmentality, we performed a critical discourse analysis of ‘medical professionalism’ within contemporary UK medical policy texts, including the GMC's Good Medical Practice.³

Results ‘Medical professionalism’ is increasingly constructed through discourses of accountability, safety, transparency, standardisation and lifelong learning. This new surveillance apparatus of ‘professionalism’ (e.g. revalidation, e-portfolio) produces ‘elite professionals’ and facilitates a process of self-regulation among doctors. Individuals that conform are therefore constructed as ‘good’ professionals but also as good neoliberal ‘subjects’.

Discussion Do contemporary ideas of ‘medical professionalism’ legitimise the neoliberal state and work to disempower healthcare professionals by positing them as risky individuals in need of continual improvement, surveillance and regulation? If so, what does this mean for the workforce (and the next generation of healthcare leaders)? What role does medical education play, and what can be done within the discipline to resist the transformation of healthcare professionals into neoliberal subjects that assume the legitimising functions of the neoliberal state?

Keywords: analysis; critical; discourse; policy; professionalism

References

1. Reed MI. Elites, professions, and the neoliberal state: critical points of intersection and contention. J Prof Organ 2018;5(3):297–312. https://doi.org/10.1093/jpo/joy010

2. Hyatt D. The critical higher education policy discourse analysis framework. Theory and method in higher education research, 2013:41–59. Emerald Group Publishing Limited, Leeds, doi:https://doi.org/10.1108/s1479-3628(2013)0000009006

3. General Medical Council. Good medical practice 2024. General Medical Council. Published 2024. Accessed 20 Jan 2024. https://www.gmc-uk.org/professional-standards/good-medical-practice-2024/get-to-know-good-medical-practice-2024

Helen Anne Nolan, Stanimir Stoilov, Tom Shah, Kirsty Matthews and Joanna Gass

University of Warwick

Introduction Leadership and advocacy skills are expected among medical graduates.¹ However, students are rarely represented in leadership activities in clinical settings, limiting opportunities to develop leadership skills in undergraduate education².

As part of quality assurance of undergraduate medical education, our school undertakes quality review visits to education partners at NHS trusts. Student participation here has traditionally been limited to sharing feedback on placements. Noting a gap in student representation and participation, we developed and piloted the role of student quality reviewers (SQRs) in quality review visits. Here, we explore the utility of incorporating SQRs to advocate for diverse peer views and potential for developing leadership skills in authentic settings.

Methods Students were recruited from clinical years via digital message. We developed and delivered training locally for SQRs prior to participation in a review visit. Since inception, six students have participated as SQRs across three visits. Formal evaluation was undertaken with students participating in semi-structured qualitative interviews exploring their perspectives and experiences of the training and visit process.

Results SQRs described the experience as a novel opportunity to develop professional communication and teamwork skills and improved understanding of healthcare education management. SQRs guided discussions around lived experiences of placement learning. SQRs valued opportunities to develop networks. Training was essential to enable meaningful participation.

Conclusion SQRs can offer mutual benefits to organisations undertaking reviews and ensure representation of student perspectives. Roles offer valuable learning opportunities to develop leadership competencies. Future research should consider wider benefits to relationship between medical students and faculty.

Keywords: co-creation; leadership; quality assurance; student leadership

References

1. General Medical Council. Outcomes for graduates. Updated 25 February 2020. Accessed 6 June 2020. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates

2. Jefferies R, Sheriff IH, Matthews JH, et al. Leadership and management in UK medical school curricula. J Health Organ Manag 2016;30(7):1081–1104. https://doi.org/10.1108/jhom-03-2016-0042

Michaela Vernon¹, Salma Khatun², Leah Argus¹, Katie Lupton³, Aysha Nijamudeen¹ and Paul Baker⁴

¹Manchester University NHS Foundation Trust; ²East Lancashire Hospital Trust; ³Northern Care Alliance-Oldham; ⁴North West of England School of Foundation Training and Physician Associates

Training opportunities are highly important for development as a holistic doctor and are supported by the Foundation Programme Curriculum¹ and GMC.² This retrospective, cross-sectional, mixed-methods study assessed access to training opportunities for foundation doctors (FDs) in the North West Deanery.

Data was collected over a 2-month period via survey across 24 hospitals, examining training experiences of FDs in post from August 2022 to December 2023. Quantitative data from 339 responses were analysed using inbuilt Excel tools. Qualitative data underwent analysis in NVivo, utilising cluster analysis with Pearson correlation and Jaccard coefficient. Factors such as grade of doctor, timing of rotations, specialties, types of training opportunities and local ARCP requirements were explored. Scheduled training opportunities were defined as attendance at clinics, theatre or procedural lists.

Results show that 75% of FDs had no scheduled opportunities during their foundation jobs, with only 42% attending on an ad hoc basis or on days off. Thematic analysis identified workforce challenges, culture, rotational training, high clinical workload, burnout, lack of standardisation across trusts, supervision, protected time, prioritisation of other staff (AHPs and PAs)³ and increased service provision as barriers to accessing training opportunities. FDs were overwhelmingly in favour of scheduled training opportunities and expressed these be mandatory.

Findings indicate a significant lack of access to training opportunities for FDs, with consequences such as deskilling, burnout and negative career implications. Recommendations include implementing scheduled training opportunities² per rotation for all doctors to enhance quality of training, retain the workforce, reduce inequalities in training opportunities and ultimately maintain patient safety.

Keywords: education; medical; postgraduate; skills; training

References

1. United Kingdom Foundation Programme Office. UK foundation programme curriculum 2021. 2021:88.

2. General Medical Council. The state of medical education and practice in the UK; workforce experiences. 2023.

3. ASiT (Association of Surgeons in Training). The physician associate role and its impact on surgical training and patient care. 2024.

Rohan Jain¹, Sarinah Hanna¹, Rachel Falconer¹, Claire Thornton², Ashley Meldrum¹ and Wendy Watson¹

¹University of Aberdeen; ²NHS Grampian

Introduction As per the General Medical Council, induction prior to final year medical student clinical placements fosters a safe and supportive learning environment, reducing student anxiety and improving preparedness.^1,2 The University of Aberdeen has clinical placements in a geographically dispersed campus, affiliated with multiple health boards, in urban and remote and rural locations, potentially compromising induction experience.

Aims Assess and subsequently improve the student induction experience prior to clinical placements using a standardised, electronic and accessible platform.

Methods Students were consulted, and their needs identified through focus groups including virtual meetings, informal and electronic discussion and online questionnaires. Specific student challenges included equality, diversity and inclusion and adapting to placements.

Results and discussion In total, 81% of students felt induction information quality could be improved, with 6% students stating they ‘always’ had the required induction material. A standardised, aesthetically appealing, easily absorbable schema—‘WardWelcome’—was developed and piloted for selected placements. Information included ward maps, generic and ward-specific learning opportunities tightly mapped to the curriculum and repeated teaching events. Location induction encompassed multifaith rooms, accommodation and transport information.

A pilot has commenced with anecdotal evidence from staff and students citing the information to be useful and user-friendly with formal feedback awaited.

Conclusion ‘WardWelcome’ provides a template for delivering standardised and focused induction information to senior medical students prior to clinical placements. Its visually appealing, intuitive format are central to engagement, and provide a framework which could be implemented across medical schools to improve the induction experience of students.

Keywords: anxiety; induction; rural; template; undergraduate

References

1. General Medical Council. Guidance on undergraduate clinical placements. General Medical Council, London; 2022. Accessed 22 Nov 2023.

2. Pearce R, Topping A, Willis C. Enhancing healthcare students' clinical placement experiences. Nurs Stand. 2022;37(5). https://doi.org/10.7748/ns.2022.e11887.

Syeda Tasfia Tarannum and Christina Cotzias

Chelsea & Westminster Hospital NHS Foundation Trust

As an international medical graduate (IMG) from Bangladesh, I have experienced a significant personal journey.

I overcame challenges in adapting to working in the NHS and transitioned into a postgraduate (PG) IMG education fellow to guide others on similar journeys. I navigated the social, emotional, practical and professional complexities of working in an unfamiliar country as well as a completely different healthcare system.

Having self-guided a slowly successful integration into the NHS, and overcoming the challenges to work in a clinical role for more than a year, the pivotal moment was to be appointed into the role of a PG IMG education fellow. Working with the sector-wide IMG office and drawing from my personal experiences, I now help run a monthly, week-long comprehensive induction programme to orient newly recruited IMGs.

Delivering these sessions, I realise the invaluable support such programmes could have offered during my own initiation into the NHS. By sharing and listening to the lived experiences and repeated narratives about overcoming obstacles that IMGs relate to, then actively supporting the professional growth of IMGs is empowering and humbling. This validates the power of informed mentorship.

The evolution from struggling IMG myself to a figure instrumental in the educational and pastoral support of fellow IMGs has been rewarding, knowing I have eased their transition even slightly into the NHS. I dream one day all IMGs will step into the NHS without fear, knowing support awaits them to negate challenges that may come their way.

Keywords: challenges; experiences; international medical graduate; mentorship; resilience

Heidi Stelling¹, Megan Brown¹, Bryan Burford¹, Gillian Vance¹ and Sophie Park²

¹Newcastle University; ²University of Oxford

Background Maternal deaths resulting from obstetric emergencies are increasing¹ with devastating consequences for both patients and staff. Unlike prior research focusing on simulated environments, this project explores if, how and for whom learning occurs within the complexities of the ‘genuine’ obstetric emergency.

Methods Existing literature focusses on clinical outcomes but contain educationally applicable insights which a realist review (RR) offers the means to extract. RR does not restrict data sources²; literature was acquired through systemic searching of key databases, as well as backward and forward citation searches and grey literature. RR actively encourages utilising the unique expert insights of stakeholders³; three stakeholder groups were engaged; patients and public, healthcare staff (which was further divided into first and second responders) and system leaders.

Results Evolution of the theory is still ongoing but initial insights have focused on three key areas: readiness, reasoning and reflection as a continuum of before, during and after, respectively. Interesting dynamics on the ‘readiness–before’ if the ‘reflection–after’ did not occur are being explored. The scope of the project is being iteratively focused alongside the stakeholder groups to ensure maximal end user relevance.

Conclusions This RR has improved understand of contextualised causation, of intended, and unintended, outcomes, from obstetric emergencies, through the lens of learning. This refined explanation will provide a robust foundation for future research which will involve the co-production, with stakeholders, of evidence-based recommendations and educational resources to optimise learning and ultimately improve patient care.

Keywords: emergencies; learning; obstetrics; postgraduate medical trainees; realist review

References

1. Knight, M., et al., Saving lives, improving mothers' care core report - lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018–20. 2022: Oxford: National Perinatal Epidemiology Unit, University of Oxford.

2. Pawson, R. and N. Tilley, An introduction to scientific realist evaluation. Evaluation for the 21st century: a handbook, 1997. 1997: 405–418, Thousand Oaks: SAGE Publications.

3. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist synthesis-an introduction. ESRC Research Methods Programme; 2004.

Namritha Ramanujam and Thomas Yeung

Great Western Hospital

Background This is a study exploring the correlation between student engagement in structured teaching sessions and their performance in assessments. It challenges the null hypothesis that student engagement is not predictive of assessment performance. It aims to provide insights into the impact of engagement in teaching sessions on student performance, potentially guiding future educational strategies in medical education. It also explores possible confounders such as baseline learning ability and specific learning needs.

Methods The study measures student engagement through a combination of objective (attendance) and subjective criteria (feedback on participation, effort, etc.). Engagement scores are collected across different teaching sessions, including case-based learning, simulation, clinical skills sessions and tutorials. A weekly average engagement score per student is calculated over 8 weeks. Assessment performance is measured as the improvement seen in scores in the ‘Clerking with Actors’ (CWA) session at week 1 and at week 8. We have also collected student self-assessment engagement scores adapted from the ‘Intrinsic Motivation Inventory’.¹

Results Preliminary data (n = 12) from CWA on week 1 following three teaching sessions does not suggest a clear trend where higher engagement scores correlate with a greater assessment performance. Detailed results will be presented, showing the relationship between total engagement scores and relative improvement in assessment performance following 8 weeks of data collection and another CWA.

Keywords: assessment performance; medical education; student engagement; teaching effectiveness

Reference

1. vanSeters, JR, Ossevoort, MA, Tramper, J, & Goedhart, MJ. The influence of student characteristics on the use of adaptive e-learning material. Comput Educ. 2012; 58(3): 942–952. https://doi.org/10.1016/j.compedu.2011.11.002.

Garrett Hess¹, Susan Miles² and Lesley Bowker^1,2

¹Norfolk and Norwich University Hospital; ²University of East Anglia

Background Ahead of planned increases in student numbers, in 2018–2019, we examined the impact on undergraduate medical students of encountering other students on secondary care placements.¹

We continue to monitor this and are now examining changes over time.

Method Following one secondary care placement in each of four academic years (2018–2019, 2019–2020, 2021–2022, 2022–2023), all Year 1–5 medical students studying on Norwich Medical School's undergraduate MBBS indicated the frequency (‘no’, ‘yes occasionally’, ‘yes often’) of experiences with other students that negatively or positively impacted learning via end-of-module evaluation forms.

Results Total number of MBBS students increased by 17% between 2018 and 2019 (N = 842) and 2022–2023 (N = 1015), alongside increased numbers for other healthcare students at the placement locations. Three thousand two hundred seventy-one of 3499 students (94%) consented for their data to be published.

Non-parametric analysis (Kruskal–Wallis, followed by post hoc Mann–Whitney, tests) indicated no differences in the frequency of positive or negative encounters over the four time periods for Year 1 and 5 students. As in 2018–2019, first year students reported most positive encounters, and final year students reported most negative encounters every year.

While there were no differences in the number of negative encounters, Year 3 and 4 students reported fewer positive encounters in recent years.

Point of view While there is no evidence of increasing negative interactions, positive interactions appear to be dwindling as student numbers increase. Educational interventions that improve collaboration and co-learning may help reduce the impact of overcrowding; small-scale local examples will be discussed.

Keywords: medical student; overlap; placement; student experience

References

1. Garrett Hess, Susan Miles & Lesley K Bowker (2022). Placement overlap with other students; effects on medical student learning experience. Teach Learn Med, 34:4, 368–378, DOI: https://doi.org/10.1080/10401334.2021.1946400

Caitlin O'Donovan, Isabella Smith, Benjamin Doughty, Anna Morgan, Rachel Grayson, Maria Hanhausen and Alison Kelly

University of Bristol

Background Prioritising psychological safety during simulation-based education (SBE) is prominent throughout the literature. Research shows elevated stress can be detrimental to learning¹ and is more common when students feel pushed beyond their capabilities. Medical students report feeling unprepared for paediatric SBE, partly due to relatively low exposure to paediatrics during undergraduate training. Literature suggests the surprise element of SBE is not necessary and may be counterproductive to learning.²

Method This aims to determine whether providing fourth year medical students with teaching ahead of their simulation scenario reduces anxiety and improves learning. After randomisation, the control group will have the standard simulation delivery: a short pre-brief followed by the scenario and a structured debrief. The intervention group will receive a short teaching session on the simulation topic before doing the same.

Both groups will be asked to complete a questionnaire assessing acute stress and anxiety before the scenarios and again following debrief. Students will also be asked to complete a short quiz, testing their theoretical knowledge of subjects covered throughout the day. Data analysis of these two measures will look for statistical differences and correlation between groups.

Results Pending at the time of submission.

Discussion We will consider the strengths and limitations of providing students with an extended pre-brief including a short teaching session on the upcoming simulation scenario. We will discuss the potential impact of this modification and whether there is evidence to propose a change in delivery of undergraduate paediatric SBE.

Keywords: education; paediatrics; pre-brief; simulation; undergraduate

References

1. LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med 2009;84(10):S25-S33. https://doi.org/10.1097/ACM.0b013e3181b37b8f

2. Monteiro S, Sibbald M. Aha! Taking on the myth that simulation-derived surprise enhances learning. Med Educ 2020;54(6):510–516. https://doi.org/10.1111/medu.14141

Holly Mould¹, Jonathan Abbas², Nick Culley² and Andrew Kinshuck¹

¹Aintree University Hospital; ²ExR Solutions

Background Virtual reality (VR) trainers have been shown to increase surgical competence and confidence,^1,2 and VR has been recommended as a training modality for bronchoscopy.³ A novel VR paediatric bronchoscope assembly trainer (PBAT) was therefore developed and evaluated.

Methods Twenty ENT trainees completed the PBAT then undertook an expert-derived evaluation consisting of the validated systems usability scale, a further 5 questions on a 1–5 Likert scale and a free-text comment box.

Results The PBAT performed well on the systems usability scale, with trainees wanting to use it frequently as a teaching tool (mean score 4.2, SD 0.678) and finding the functions of the system well integrated (mean score 4.2, SD 0.698). Trainees found the PBAT an engaging way to learn (mean score 4.25, SD 0.698) and stated it increased their confidence in assembling paediatric bronchoscopes (mean 4.1, SD 1.023). Thematic analysis of the seven free-text responses demonstrated an overall positive response to the PBAT, with a desire for further training procedures to be developed. Trainees agreed that an added tutorial would be helpful (mean score 3.55, SD 0.973), and this was also a common theme in the free-text responses.

Learning points The PBAT provides an engaging way for ENT trainees to learn the procedural steps of paediatric bronchoscope assembly. It increases trainee confidence, although would benefit from a tutorial of the controls.

Keywords: otolaryngology; virtual reality; postgraduate; education

References

1. Arora A, Lau LYM, Awad Z, Darzi A, Singh A, Tolley N. Virtual reality simulation training in otolaryngology. 2013. https://doi.org/10.1016/j.ijsu.2013.11.007

2. Fang TY, Wang PC, Liu CH, Su MC, Yeh SC. Evaluation of a haptics-based virtual reality temporal bone simulator for anatomy and surgery training. Comput Methods Prog Biomed 2014;113(2):674–681. https://doi.org/10.1016/j.cmpb.2013.11.005

3. Deutsch ES, Christenson T, Curry J, Hossain J, Zur K, Jacobs I. Multimodality education for airway endoscopy skill development. Ann Otol Rhinol Laryngol 2009;118(2):81–86. https://doi.org/10.1177/000348940911800201

Dengyi Zhou¹, Anisah Ali² and Pavithra Sakthivel²

¹Department of Metabolism, Digestion and Reproduction, Imperial College London; ²College of Medical and Dental Sciences, University of Birmingham

Background Modern clinical practice is witnessing the integration of technological advances, particularly in managing Type 1 diabetes mellitus (T1DM).¹ User-friendly smartphone applications like Dexcom and FreeStyle Libre play a crucial role in enhancing diabetes monitoring.¹ Simulation via Instant Messaging—Birmingham Advance (SIMBA)^2,3 conducted simulation training aiming to improve healthcare professionals' (HCPs) knowledge and confidence in managing T1DM using technological advances.

Methods Anonymised case transcripts were created based on real-life clinical scenarios involving the management of T1DM using FreeStyle Libre and Dexcom G6. Moderators simulated these cases via WhatsApp followed by a discussion session led by a topic expert. Pre- and post-SIMBA surveys were distributed to measure the change in clinicians' confidence using Wilcoxon signed-rank test. Thematic analysis of HCPs' experience of SIMBA was conducted.

Results Twenty-one HCPs responded to both pre- and post-SIMBA surveys. Participants' self-reported confidence for FreeStyle Libre and Dexcom G6 improved from 66.7% and 33.3% to 90.5% (p = 0.0143) and 76.2% (p = 0.0009), respectively. 95.2% of participants agreed that the simulated topics applied to their clinical practice and reported that the simulation training had a positive influence on their knowledge of patient management and care provision.

Thematic analysis revealed that participants were more confident in offering continuous glucose monitoring (CGM) to their patients and interpreting data produced by CGM applications.

Conclusion SIMBA is a simulation-based training programme that has improved HCPs' knowledge and confidence of utilising technological advancements for T1DM management, in turn encouraging HCPs to offer these tools more widely and potentially leading to improved patient outcomes.

Keywords: education; diabetes; medical; simulation; technology

References

1. Friedman JG, Cardona Matos Z, Szmuilowicz ED, Aleppo G. Use of continuous glucose monitors to manage type 1 diabetes mellitus: progress, challenges, and recommendations. Pharmgenomics Pers Med. 2023;16:263–276. https://doi.org/10.2147/PGPM.S374663

2. Melson E, Davitadze M, Aftab M, Ng CY, Ooi E, Blaggan P, Chen W, Hanania T, Thomas L, Zhou D, Chandan JS, Senthil L, Arlt W, Sankar S, Ayuk J, Karamat MA, Kempegowda P Simulation via instant messaging-Birmingham advance (SIMBA) model helped improve clinicians' confidence to manage cases in diabetes and endocrinology. BMC Med Educ. 2020;20(1):274. https://doi.org/10.1186/s12909-020-02190-6

3. Zhou D, Davitadze M, Ooi E, Ng C.Y., Allison I., Thomas L., Hanania T., Blaggan P., Evans N., Chen W., Melson E., Boelaert K., Karavitaki N., Kempegowda P., on behalf of SIMBA and CoMICs team. Sustained clinical knowledge improvements from simulation experiences with simulation via instant messaging-Birmingham advance. Postgrad Med J 2023;99(1167):25–31. https://doi.org/10.1093/postmj/qgac008

Alice Cranston and Marie Astrid Garcia Verstraete

Buckinghamshire NHS Trust

Moulage, the art of creating realistic wounds and medical conditions on simulated patients, is a valuable simulation tool in medical education that enhances the training of future healthcare professionals. Its ability to create lifelike medical scenarios, engage learners and provide a safe and standardised learning environment makes it an essential component of modern medical curricula. This paper discusses the benefits of using, considerations to take and the techniques to moulage.

The integration of mannequin-based simulators into surgical training is likely to become more prevalent, expanding the potential for practice and setting new standards for surgical training.

In specialised areas like ophthalmology, where precision and delicate procedures are paramount, innovative training tools are essential. Repairing eyelid margin trauma is a valuable skill that is seldom encountered, making it suitable for practice within a simulated setting. Furthermore, it falls within the category of competencies that are challenging to attain in the current specialty training curriculum. Unfortunately, previous eyelid models that have been produced are not readily available in the UK.^1,2 As a result, porcine cadaveric material has been utilised for simulations, although it is not an ideal substitute for human skin and comes with it logistical complications. A mannequin-based surgical simulator for eyelid laceration surgical training offers a controlled and realistic environment for learners to acquire and refine their surgical skills. Within this paper, there is a pictorial demonstration of how to make a mannequin-based eyelid model, what equipment is required and the cost associated with the production.

Keywords: eye model; eye; eyelid laceration; moulage; ophthalmology; surgical training

References

1. Zhao J, Ahmad M, Gower EW, Fu R, Woreta FA, Merbs SL. Evaluation and implementation of a mannequin-based surgical simulator for margin - involving eyelid laceration repair - a pilot study. BMC Med Educ. 2021;21(1):170. https://doi.org/10.1186/s12909-021-02600-3.

2. Nicole Lifson, David Booy, Joseph Crozier, Yash Vaishnav, John Nguyen, Bradley Thuro, Albert S Woo, Michael E Migliori, Jamie Schaefer; A novel 3D printed silicone simulation model for effective instruction of marginal eyelid laceration repair. Ophthalmol vis Sci2022;63(7):1072–A0167.

Catherine Kellett, Shaikha Al Zaabi, Paddy Kilian, Nusrat Khan, Sam Ho, Hani Benamer, Riad Bayoumi and Adrian Stanley

Mohammed Bin Rashid University

Background Simulation and self-assessment are important tools for establishing lifelong learning.^1,2 This study examines student self-assessment of four ward simulation exercises during final year of a new MBBS programme.

Method Year 6 students undertook four hospital ward simulation exercises over a year. Each simulation was progressively more complex, covering several educational domains. For every simulation, students were assessed by two faculty using entrustable professional activities (EPAs) and a 5-point Likert global rating score (GRS). Students completed a self-assessment (similar to GRS) immediately after the simulation, then again after viewing their performance video. Analysis with Pearson's R and ANOVA were used to investigate any faculty assessment and student self-assessment correlation.

Results Forty-two students performed the simulation exercises with 27 different clinical faculty. Four hundred twenty-eight faculty–student encounters were recorded. Mean faculty simulation EPA scores significantly correlated with student mean pre-video (Pearson's = 0.33, p = 0.033) and post-video (Pearson's = 0.376, p = 0.014) self-assessment. There was no correlation with student evaluation of the learning. Students who scored themselves as ‘fail’, ‘borderline’ or ‘pass’ (n = 26) on the first post-video self-assessment demonstrated significantly increased post-video self- assessment score over the year (+32.8%, p = 0.04). This correlated with the mean faculty simulation EPA score. The students who scored themselves as ‘good’ (n = 13) in the first simulation post-video self-assessment did not show increased self-assessment scores, despite faculty simulation EPA score increasing.

Conclusion In a formative hospital ward simulation environment, student self-assessment aligns with faculty assessment of their performance. Increased experience of simulation exercises leads to an improvement in student self-assessment, but only in lower scoring students.

Keywords: Simulation exercise, Self-assessment, Reflection, Assessment, Complex simulation.

References

1. Gerald A. Isenberg, Vibin Roy, Jon Veloski, Katherine Berg, Charles J. Yeo. Evaluation of the validity of medical students' self-assessments of proficiency in clinical simulations. J Surg Res. Volume 193, Issue 2. 2015. 554–559. https://doi.org/10.1016/j.jss.2014.09.036.

2. MacMillan C and Hogg G. Exploring student perceptions of ward simulation as an exercise to improve decision-making skills in the clinical context [version 1] MedEdPublish 2018, 7:18 https://doi.org/10.15694/mep.2018.0000018.1

Rachel Greyson, Caitlin O'Donovan, Regina Hanhausen, Anna Morgan, Isabella Smith, Benjamin Doughty and Alison Kelly

University of Bristol

Background High-fidelity multidisciplinary team (MDT) simulation has improved teamwork across disciplines and resulted in improved patient outcomes.^1,2 There is currently no specific learning event within the University of Bristol's (UoB) undergraduate medical curriculum that focuses on interprofessional learning and teamwork in paediatrics.

Methods Two different simulation scenarios on paediatric emergencies will be delivered from a simulation suite to final-year medical students from UoB and final-year nursing students from University of the West of England Bristol (UWE Bristol). The study aims to assess whether delivering a paediatric MDT simulation alters student perception of the roles of different team members and whether it impacts student confidence of working within an MDT at paediatric emergencies. A Likert-scale questionnaire will be completed before and after the simulation scenario, and a structured debrief will follow each scenario. Data from the questionnaires will be analysed to assess for a statistically significant change in student attitudes, while thematic analysis of debrief discussions will aid in contextualising qualitative data.

Results Pending at time of submission.

Discussion We will consider the strengths and limitations of delivering an MDT paediatric simulation for medical and nursing students, evaluating the impact on student learning, teamwork and confidence in dealing with paediatric emergencies. We will consider if this method of simulation-based education should be included routinely in both the UoB and UWE Bristol undergraduate teaching.

Keywords: interprofessional education; multidisciplinary team; simulation; teamwork; undergraduate paediatrics

References

1. Krielen P, Meeuwsen M, Tan ECTH, Schieving JH, Ruijs AJEM, Scherpbier ND. Interprofessional simulation of acute care for nursing and medical students: interprofessional competencies and transfer to the workplace. BMC Med Educ. 2023;23(1):105. https://doi.org/10.1186/s12909-023-04053-2

2. Cates LA. Simulation training: a multidisciplinary approach. Adv Neonatal Care 2011;11(2):95–100. https://doi.org/10.1097/ANC.0b013e318210d16b

Lalit Mishra, Cathryn Buechel, Abbas Mohamed, Aishah Anas and Rajesh Dwivedi

University of Nottingham NHS Trust

Background In medicine, simulation offers good scope for training of interdisciplinary medical teams. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance and possibly help reduce errors.¹ However, there is a lack of literature on joint-speciality simulations. We carried out joint-simulation stations covering hip fractures, pressure ulcers and discharge planning. Simulation mannequins, role players, imaging and simulated clinical documentation were incorporated into the scenarios. We evaluated the effectiveness of this approach on students' knowledge and confidence.

Methods Over a period of 5 months, 90 fourth year medical students at the University of Nottingham received simulation-based teaching during their geriatrics placement at Queen's Medical Centre. Their knowledge and confidence levels were assessed before and after the simulations using six knowledge and confidence level-based questionnaires mapped to their learning outcomes. Any additional comments on the scenarios was also captured.

Results Eighty-five and 81 students completed the pre-simulation and post-simulation questionnaire, respectively. Our results demonstrated 18% average increase in the knowledge-based category and 60% increase in their confidence level. Additionally, 47% of the students made positive comments about the simulations.

Discussion Our findings demonstrate the effectiveness of the joint-speciality simulation approach in undergraduate teaching with a significant increase in students' confidence level. We aim to continue and expand on these joint-speciality simulations for our students. Our results indicate that a larger study with evaluation of learning over time will accurately measure the long-term effectiveness of this approach.

Keywords: confidence; interaction; joint specialty; medical education; simulation

Reference

1. Lateef F. Simulation-based learning: just like the real thing. J Emerg Trauma Shock 2010;3(4):348–352. https://doi.org/10.4103/0974-2700.70743.

Jessica Gillard

Royal Free London NHS Foundation Trust

A survey on training for anaesthetic trainees and consultants collected quantitative data on educational satisfaction, feedback and goal-setting conversations and qualitative data on perceived obstacles to learning. Common issues trainees reported included perceived missed educational opportunities due to lack of communication; time pressures overshadowing training needs; limited relationships with consultants; and a lack of consultant familiarity with the updated curriculum.¹

Based on findings, consultants were recommended to hold a short ‘check-in’ conversation at the start of shifts—covering the learner's aims for the day and any specific curriculum needs. Teaching was delivered to trainees and trainers on the ‘check-in’ initiative and its goals and on feedback structures; summaries sent in departmental emails and newsletters; and posters put up. To assess the success of the interventions, monthly survey scores for educational satisfaction, alongside frequency of ‘check-ins’ and feedback, were compared.

Good response rates across the department (>50%) reflected high engagement. Increasing satisfaction (7 to 7.9 out of 10) positively correlated with the frequency of ‘check-ins’ (from 50% to 80%) and feedback. Trainees' average rating of whether they achieved their goals for the shift improved from 6.6 to 8.2 over 3 months.

One hundred per cent of trainees and consultants said that having the initial ‘check-in’ conversation had no significant delay or negative impact on patient care.

In summary, the use of senior-led educational “check-ins” at the start of shifts led to higher trainee educational satisfaction and a greater sense of achieving their daily goals, without causing any detriment or delays to patient care.

Keywords: communication; personalised; postgraduate; training; well-being

Reference

1. Royal College of Anaesthetists 2021 curriculum. Accessed 20/01/2024. https://www.rcoa.ac.uk/2021-curriculum-cct-anaesthetics

Jessica Bray

University of East Anglia

At Norwich Medical School, practice development tutors (PDTs) provide support for GP tutors in their teaching role. PDTs visit GP practices to observe GP tutor teaching and conduct peer observation as part of a quality assurance programme. The main objective of primary care-based teaching is to provide students with patient contact. Guided by the GP tutor, students consult with invited patients with lived experience of a particular condition. Such teaching consultations are complex learning activities involving multiple participants, with GP tutors drawing on their experience as clinicians and educators.

Recognised frameworks exist for peer observation within teaching; however, these lack descriptors of clinical components. Widely used consultation guides such as Calgary-Cambridge model¹ are based on the traditional dyadic medical consultation between a doctor and patient. The linear nature of such models limits their application in more complex situations with multiple participants. Triadic consultations such as those involving doctor–patient–interpreter or doctor–carer/parent–patient/child have attracted growing interest, for example, Swinglehurst et al. have proposed a reflective toolkit for analysis of these complex interactions.²

Reflecting on my personal experience as a PDT, this presentation will propose that translating the concept of triadic consultation to the context of health professional education may provide a framework with a useful set of descriptors for the teaching consultation involving patient, student and doctor (educator).

Keywords: medical education; peer observation; triadic consultation

References

1. Kurtz S, Silverman J. The Calgary-Cambridge referenced observation guides: an aid to defining the curriculum and organising the teaching in communication training programmes. Med Educ 1996;30:83–89.

2. Swinglehurst D, Roberts C, Li S, Weber O., Singy P. Beyond the ‘dyad’: a qualitative re-evaluation of the changing clinical consultation. BMJ Open 2014;4:e006017. https://doi.org/10.1136/bmjopen-2014-006017

Aisling Kelly and Meera Kattakayam

Bradford Teaching Hospitals NHS Foundation Trust

This project explores the experiences of fourth year medical students from Leeds Medical School. The simulation-based teaching was delivered during their acute and critical care (ACC) placement at Bradford Teaching Hospitals.

A teaching programme was created to improve medical student ability in completing an A–E assessment of an acutely unwell patient. A 5-week programme was delivered over 2 years to more than 80 medical students. This consisted of one full day of teaching with a morning lecture on a specific component of the A–E assessment, followed by an afternoon completing simulation scenarios in pairs using an interactive mannequin. A student-focused debrief following each scenario focused on A–E assessment, investigations, management, SBARR and communication.

We collected subjective data using a pre-course questionnaire. This consisted of seven questions using a 10-point Likert scale to measure student confidence in their ability to assess and manage issues in the A–E assessment. The post-course questionnaire contained similar questions and additional qualitative feedback on the course.

Simulation can be an unfamiliar teaching style for many healthcare professionals. Therefore, this year the focus was on improving confidence of faculty members on the facilitation of ACC Simulation. This incorporated an induction to simulation, weekly ACC huddle and the creation of an educators guide to facilitating ACC Simulation.

Overall, in the past 2 years, we have formulated clear materials and guidance on facilitating a simulated teaching programme that has significantly improved the confidence of fourth year medical students in assessing an acutely unwell patient.

Keywords: assessment; communication; education; innovation; simulation

Rania Salaheldien¹ and Amy Wai Yee Wong²

¹Mohamed Ahmed University of Sharjah; ²University of East Anglia

Background Integrating telemedicine into the undergraduate medical curriculum has shown to equip students with the essential knowledge and skills,¹ which contribute to high-quality patient care in the virtual context. The aim is to evaluate the effectiveness of introducing telemedicine through an interactive workshop on the fourth year medical students' knowledge and understanding of telemedicine.

Methodology A change management model² guides the development and implementation of a 5-h interactive workshop, which includes delivery of telemedicine knowledge including the ethical issues, group training on the best communication skills with active role-playing activities and reflection. Students were asked to complete pre- and post-workshop surveys to self-report their perception of knowledge and understanding of telemedicine. Descriptive statistics was used to analyse the data.

Results Of 96 students, 43(44.8%) completed the pre-workshop survey, and 35(36.4%) completed the post-workshop survey. Students reported their understanding of telemedicine terminology as ‘knowledgeable/very knowledgeable’ has increased (16.3%–88.6%), especially their knowledge of the steps involved in a telemedicine consultation (7%–97.1%). An increase was also reported in students' efficacy (ability) of using telemedicine (32.6%–91.5%) and their ethical awareness (28%–91.4%).

Discussion The interactive workshop was a successful introduction to telemedicine to increase undergraduate medical students' knowledge and skills in conducting telemedicine consultations. As there is an increasing demand for telemedicine globally, the workshop provides a basic structure of a starting point for integrating telemedicine into the medical curriculum that the core elements could be easily adaptable to different cultural contexts.

Keywords: evaluation; curriculum; medical students; telemedicine; undergraduate

References

1. Iancu AM, Kemp MT, Alam HB. Unmuting medical students' education: utilizing telemedicine during the COVID-19 pandemic and beyond. J Med Internet Res 2020;22(7):e19667. https://doi.org/10.2196/196673

2. Health Service Executive. Improving our services: a user's guide to managing change in the health service executive. 2008. Retrieved from: http://hdl.handle.net/10147/46104

Alice Cranston and Suleiman Ayoub

Buckinghamshire Healthcare Trust

Foundation doctors encounter stress and obstacles in specialty applications,¹ particularly regarding teaching experiences with an additional demanding task of organising regional teaching programmes. These challenges often impede doctors from obtaining crucial application points.

To address this, the ‘After-School Skills Club’ was launched at Buckinghamshire NHS trust. Over 50% of foundation doctors participated, attending a presentation on basic education theory^2,3 and signing up for sessions to teach medical students from three universities, via a Google form, scheduled after 17:00 (‘after-school’).

The project empowered doctors with independence to organise sessions, covering topics such as key subjects, clinical skills, examination overviews and ‘on-call’ simulations. This approach allowed for the incorporation of a hidden curriculum, fostering a comfortable environment for questions and interactions.

Sessions, accommodating up to 20 students, received 100% satisfaction, with significant student learning outcomes. Results indicated the teaching doctors had an increased confidence in teaching, an enjoyable experience and attributed career progression to the project.

The ‘After-School Skills Club’ effectively addressed the challenge of gaining teaching opportunities for foundation doctors, fostering skill development and career advancement. Simultaneously, it provided students with a secure environment to enhance knowledge and skills beyond formal teaching settings.

Keywords: near-peer education; portfolio; programme; teaching

References

1. Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study. Accessed 18 Jan 2024. https://doi.org/10.1136/bmjopen-2019-031765

2. Gagné, R. M., Briggs, L. J., & Wager, W. W. (1992). Principles of instructional design (4th ed.). Forth Worth, TX: Harcourt Brace Jovanovich College Publishers.

3. Adams, N.E. (2015) ‘Bloom's taxonomy of cognitive learning objectives’, J Med Libr Assoc, 103(3), pp. 152–153.

Shivam Choudhary¹, Maiar Elhariry¹, Pavithra Sakthivel¹, Sangamithra Ravi¹, Tamzin Ogiliev², Abby Radcliffe¹, Rahul Sagu¹ and Dengyi Zhou³

¹College of Medical and Dental Sciences, University of Birmingham; ²Lancaster University Medical School; ³London North West University Healthcare NHS Trust

Introduction Simulation via Instant Messaging—Birmingham Advance (SIMBA) is a virtual, simulation-based medical training model designed to enhance clinicians' confidence. Despite its proven efficacy, the model lacks patient input. This study addresses this gap by engaging patients and the public in formulating reproductive endocrinology cases via WhatsApp, aiming to guide clinicians in aligning management with patient concerns.

Method In September 2023, a 2-day conference simulated nine reproductive endocrinology cases, including PCOS, thyroid disease, premature ovarian insufficiency, menopause, azoospermia, opiate-induced hypogonadism, idiopathic hypogonadism and Kallmann syndrome. Real patient cases were anonymised for confidentiality.

Public participants evaluated case representativeness and suggested improvements in workshop-style discussions. Experts in reproductive endocrinology later discussed the cases. Pre- and post-SIMBA surveys assessed participants' self-perceived improvements in confidence, ACGME Core Competencies and perceptions of SIMBA. Quantitative analysis used the Wilcoxon signed-rank test¹, and qualitative analysis focused on open-ended questions through thematic analysis.

Results Twenty-nine participants completed both surveys, reporting a significant confidence increase from 36.54% to 88.62% on Day 1 and 36.54% to 84.62% on Day 2 post-session. ACGME Core Competencies improvements included knowledge, system-based practice and practice-based learning (100%) and patient care and professionalism (96.55%). Participants overwhelmingly rated the session positively, with 100% indicating excellence or goodness and 93% expressing willingness to attend future sessions. Thematic analysis revealed enhancements in clinicians' clinical knowledge and communication skills.

Conclusion Patient involvement in SIMBA effectively boosts clinicians' confidence in reproductive endocrinology. Scaling SIMBA in larger studies will assess its long-term effectiveness in simulation-based learning for reproductive endocrinology.

Keywords: education; endocrinology; medical; patient experience; simulation

Reference

1. Individual comparisons by ranking methods on JSTOR. Jstor.org. Published 2018. Accessed 2023. https://www.jstor.org/stable/3001968?origin=crossref&saml_data=eyJzYW1sVG9rZW4iOiJiOTEyN2EzYS02NDg1LTQxOWQtOTEzYy0yMjgyZmI1YTI1YmIiLCJpbnN0aXR1dGlvbklkcyI6WyIxMTI1NzY5Yi0xMDZmLTRjYzYtODY1ZS02ZTQ5M2MyZTNiN2MiXX0

Hannah Okechukwu¹ and Shonnelly Novintan²

¹Imperial College London; ²East Suffolk and North Essex NHS Trust

Objectives The British Medical Association announced a successful vote towards industrial action to achieve ‘pay restoration’ on 24 February 2023: nine walkout periods followed soon after.¹ During industrial action, concerns arose about the role medical students would play and the pressure placed upon them to ‘act up’.² The objective of this study was to assess the guidance issued by medical schools and local placement sites during industrial action.

Design, setting and participants This cross-sectional study collected online survey data between 7 March 2023 and 7 April 2023 from medical students across England.

Main outcome measures Reports about guidance issued by medical schools and hospital placements.

Results Sixty-two per cent of the medical schools issued guidance stating they were not cancelling clinical placements; of these, 10% said attendance was a personal choice. Seventeen per cent of medical schools cancelled all clinical placements, and 7% did not issue guidance. Fifty-two per cent of medical schools monitored attendance on strike days.

One medical school and three clinical placement sites advertised paid work for students during the industrial action.

Conclusion The impact industrial action has on medical students has not been examined. Our results show mixed guidance from medical schools that can contradict local placement guidance. This lack of guidance is mirrored in the existing, yet limited literature.³ If students feel pressured to perform tasks outside their remit, it can have consequences for patient safety and their future careers. For the safeguarding of students and patients, further work is needed to produce standardised guidance during industrial action.

Keywords: education; guidance; medical; strike; support

References

1. NHS England. NHS London warns of ‘significant disruption’ over 10 days as industrial action continues. Published July 2023. Accessed January 22, 2024. https://www.england.nhs.uk/london/2023/07/12/nhs-london-warns-of-significant-disruption-over-10-days-as-industrial-action-continues/

2. Griffin L, Politis M. Junior doctors' strike—what do medical students need to know?. BMJ 2023;380: 571.

3. Gouda P. When doctors go on strike, where do the medical students go?. Ir Med J 2014; 107(2): 59.

Priyank Shukla

Personalised Medicine Centre, School of Medicine, Ulster University

The BSc Hons in Personalised Medicine programme at the School of Medicine, Ulster University, is a multidisciplinary course, where we teach computer programming to our students from a cross-disciplinary perspective. Earlier, we have argued in an opinion piece¹ that multidisciplinary courses are very challenging to learn because of the number of subjects involved, their diverse nature and aptitude required to learn them.

Computer programming is considered a difficult subject, especially for students who come from a non-computing background. Computing concepts are generally difficult to learn, especially abstract computer terms such as executables and subroutines. In a previous study,² we have shown that personalised medicine students find learning computer programming skills cognitively challenging. In our currently ongoing mixed-methods research, which has been approved by Ulster University's ethics filter committee (project number: CHERP-22-010-B), we are implementing a two-stage assessment approach³ with an aim to measure indicators of its success in improving the learning experience and development of competencies and skills required for a career in data science side of personalised medicine. Data collection in this study involves implementation of quantitative and qualitative surveys, collation of management data, anonymised historic data of students' performance in assessments and service evaluation and past funded project questionnaires. Qualitative data analysis is being performed thematically to contextualise, complement and contrast with the quantitative data. Our preliminary data analysis results indicate that two-stage assessment is not only effective in terms of students learning experience, but it also helps in addressing their stress and anxiety towards computer programming.

Keywords: assessment; multidisciplinary; personalised medicine; positive pedagogy; problem-based learning

References

1. Shukla P, McClean S, Hidson E. The need for positive pedagogy in multi-disciplinary STEM courses in higher education: an opinion piece. High Educ Pedagog. 2020;5(1):324–326. https://doi.org/10.1080/23752696.2020.1847161

2. Shukla P, McClean S, Hidson E. An intervention through teaching and learning practice to address stress and anxiety in students caused by the challenges of studying a cross-disciplinary subject. Advance HE. Published 2019. Accessed 20 Jan 2024. https://www.advance- he.ac.uk/knowledge-hub/intervention-through-teaching-and-learning-practice-addressing-stress-and-anxiety

3. Lindsley JE, Morton DA, Pippitt K, Lamb S, Colbert-Getz JM. The two-stage examination: a method to assess individual competence and collaborative problem solving in medical students. Acad Med. 2016;91(10):1384–1387. https://doi.org/10.1097/acm.0000000000001185

Georgina Shajan and Pamela Hagan

University of Nottingham

Autistic medical students face many challenges academically and socially, which can impact their physical and mental well-being as well as educational satisfaction.¹ With increasing numbers of medical students declaring neurodiversity,² there is a need to support and understand appropriate accessibility requirements, make necessary adjustments, identify possible barriers and share good practices. This will maximise the potential of this group of students and our future doctors.

An extended literature review using a systematic methodological approach was carried out to identify and inform areas for improvement and intervention and to maximise the experience and support of autistic students.

Further work based on these results includes the development of a support toolkit (due for completion in May 2024), which will be appropriate for use by both teacher and autistic learner. The toolkit will contain suggested strategies, resources and inclusive practice advice in order to create better conditions for neurodivergent thinkers to thrive and to maximise their potential during medical school and training. Additionally, it will include advice to enable the educationalist to ensure curriculum, assessment and environmental accessibility.

Keywords: autism; education; medical; neurodiversity; support

References

1. Shaw SCK, Doherty M, Anderson JL. The experiences of autistic medical students: a phenomenological study. Med Educ, 2023. https://doi.org/10.1111/medu.15119

2. Clouder L, Karakus M, Cinotti A, Ferreyra MV, Fierros GA, Rojo P. Neurodiversity in higher education: a narrative synthesis. High Educ 2020;80(4):757–778. https://doi.org/10.1007/s10734-020-00513-6

Julia McLaughlin, Katherine Baker, Karen Brown, Tracy Sandell and Christopher James

Withybush Hospital

Background Developing a new service and team can be challenging when navigating multidisciplinary collaboration, requiring team awareness of each practitioners' background, competencies and clinical confidence. This research assesses the effectiveness of interprofessional simulation (IPSim) in identifying knowledge gaps among healthcare professionals (HCP) within the context of a new hospital-at-home (H@H) service.

Previously, simulation has been used to ‘test-drive’ services,¹ but it is potential to serve as a tool to bring awareness to different abilities within new teams, and individual educational needs have been underutilised.

Methods The H@H team consists of existing community and secondary care teams; IPSim frameworks² were employed to encourage effective communication and achieve shared care. Insights were collated by questionnaire to assess prior experience of simulation, self-rated confidence and learning post-IPSim.

Outcomes Results demonstrated a team-wide increase in confidence (self-rating average increased 5.31–7.77). The majority (85%) reported simulation enhanced their understanding of their H@H role, and 92% reported improved understanding of the service. Furthermore, 92% identified their own knowledge/training gaps.

IPSim identified areas for improvement but also facilitated knowledge and experience integration within the team, surpassing simply ‘test-driving’ the service by enhancing team awareness/confidence.

Learning points/further research The use of IPSim can establish educationally robust pathways, ensuring effective service functioning and professional development opportunities. Further research is needed to investigate how IPSim can close knowledge gaps, leading to sustained competence and confidence in the context of a new service. The team insights highlight IPSim's potential as a tool for professional and service development in evolving healthcare environments.

Keywords: interprofessional; postgraduate; multidisciplinary; new service; simulation

References

1. Adler M, Mobley B, Eppich W, Lappe M, Green M, Mangold K. Use of simulation to test systems and prepare staff for a new hospital transition. J Patient Saf 2018;14(3):143–147. https://doi.org/10.1097/pts.0000000000000184

2. Xavier N, Brown M. Interprofessional education in a simulation setting. StatPearls. Published online 31 May 2020. https://europepmc.org/article/MED/32491403

Maya Alazzawi and Kyle Lam

Imperial College London

Introduction The popularity of large language models (LLMs) has grown exponentially across healthcare.¹ Despite the wealth of literature on proposed applications within medical education,² little research has investigated their real-world use. We aimed to determine the benefits, facilitators and barriers to the use of LLMs for education using semi-structured interviews of UK medical students.

Methods Topic guides for interviews were structured around the technology acceptance model, a widely applied model of users' acceptance and usage of technology.³ Questions surrounded the perceived ease of use and benefits of LLMs within medical education. Transcripts were subsequently analysed using an inductive thematic analysis approach.

Results Fifteen students covering all years of medical school were interviewed. All participants had experience in using LLMs to provide summaries of medical topics. Most participants preferred the use of LLMs to conventional search engines. However, participants were wary of potential inaccuracies and hallucinations. Most participants were not aware of many potential applications of LLMs including the creation of flashcards or quizzes and simulation of doctor–patient interactions. Finally, some participants felt use of LLMs led to overreliance on this technology and more factual recall, resulting in shallower exploration of topics.

Conclusion Medical schools should educate students on how best to harness the benefits of LLMs while highlighting perceived risks and limitations. It is only through this that proposed applications within the literature can be truly translated into real-world education. Finally, medical schools should design future assessment processes in the context of the growing uptake of LLMs among medical students.

Keywords: AI; generative; language; large; models

References

1. Webster P. Six ways large language models are changing healthcare. Nat Med. 2023;29(12):2969–2971. https://doi.org/10.1038/s41591-023-02700-1

2. Abd-Alrazaq A, AlSaad R, Alhuwail D, et al. Large language models in medical education: opportunities, challenges, and future directions. MIR Med Educ 2023;9(1):e48291.

3. Holden RJ, Karsh B-T. The technology acceptance model: its past and its future in health care. J Biomed Inform 2010;43(1):159–172.

Benjamin Stewart¹ and Anne-Marie Reid²

¹Brighton and Sussex Medical School; ²Leeds Institute of Medical Education

Background and aims In 2009, the General Medical Council introduced ‘student assistantships’ as a mandatory element of medical curricula due to concerns about under-preparedness for practice as students transition from final year of medical school to foundation year doctors.¹ Assistantship is now established, but the guidance on the length and structure of assistantship placements is not prescribed, and so implementation mechanisms vary with limited evidence on effectiveness.

This study aimed to explore current evidence on the experience and effectiveness of assistantship through a scoping review.

Methods A scoping review is one approach to reviewing literature through exploring broad concepts to uncover evidence on the topic from a wide range of sources.

Between October 2022 and May 2023, literature searches were conducted on PubMed and Ovid databases to identify relevant studies which fitted the selection criteria. Data were extracted, charted and thematically analysed.

Findings Findings from the 24 studies selected revealed variance in perceptions of under-preparedness, levels of autonomous responsibility afforded, alignment with perceived purpose of assistantship and levels of integration into teams. These impacted on assistantship experience and effectiveness.

Conclusion The scoping review findings highlight the need to update guidance on affording opportunities for higher risk tasks such as managing acutely unwell patients and prescribing during assistantship, with appropriate supervision and sufficient time to enable the development of responsibility and confidence. These indicate priority areas for further research to inform ways to optimise the transition to practice.

Keywords: medical; assistantship; curriculum; education; medical; transition

Reference

1. Goldacre MJ. Preregistration house officers' views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey. BMJ 2003;326(7397):1011–1012. https://doi.org/10.1136/bmj.326.7397.1011

Amaya Ellawala¹, Alison Ledger², Harith Wickramasekara³, Madawa Chandratilake³, Rebecca O'Rourke⁴ and Pavithra Godamunne³

¹Hull York Medical School; ²University of Queensland, Brisbane, Australia; ³University of Kelaniya, Colombo, Sri Lanka; ⁴University of Leeds

Background The student–teacher relationship can impact learning.¹ Power distance² is an integral component of this relationship. This study was conducted in two contexts with contrasting power dispositions (UK: low power distance; Sri Lanka [SL]: high power distance) and aimed to answer the following: Does power distance between undergraduate medical students and teachers differ in online and face-to-face learning environments? Do these perceptions vary between SL and UK contexts?

Methods A qualitative, exploratory approach underpinned by constructivist grounded theory was taken. Medical students and teachers at the universities of Kelaniya (SL) and Leeds (UK) (n = 25) participated in online interviews and focus group discussions. Perceptions on teacher–student power distance were explored, with rich pictures used to facilitate discussions. Transcript data were coded inductively and iteratively. Drawings were analysed using aesthetic analysis.³

Results The teacher was regarded as inherently more powerful, regardless of teaching mode or context. Teachers across both contexts preferred a narrow power gap, which was perceived as more favourable for learning. Teachers and students would consciously alter this gap to support learning needs. Face-to-face learning was favoured as more conducive to building relationships, though features of online learning such as shared experiences (similar technical issues) and student autonomy could reduce power distance.

Conclusion Power distance is present in both cultural contexts, with no discernible differences between the two. An ideal power gap can enable learning. Both online and in-person environments have features that magnify and diminish power distance. Regardless of teaching mode, teachers should manage power distance to promote learning.

Keywords: education; medical; power; relationship

References

1. Ruzycki SM, Desy JR, Lachman N, Wolanskyj-Spinner AP. Medical education for millennials: how anatomists are doing it right. Clin Anat 2019;32:20–25.

2. Hofstede G. The 6-D model of national culture. Geert Hofstede. Accessed 22 Jan 2024. http://geerthofstede.com/culture-geert-hofstedegert-jan-hofstede/6d-model-of-national-culture/

3. Cristancho SM, Helmich E. Rich pictures: a companion method for qualitative research in medical education. Med Educ 2019;53(9):916–924.

Vanessa Rodwell, Gurtek Singh Samra, Vanessa Rodwell, Vashisht Ramoutar, Muiz Chaudhry, Hrithika Patel, Kelley Chen and Terese Bird

University of Leicester

Introduction The integration of artificial intelligence (AI) in radiology holds potential to revolutionise diagnostic practices, enhancing efficiency and accuracy.¹ Pre-clinical medical students, lacking ward-based exposure, rely on online resources for X-ray interpretation, facing limitations in image variety. This study compares Chester, a free AI software, with the established peer-reviewed online textbook, Radiopaedia. We investigate whether Chester can generate accurate interpretations for a broader range of diverse chest X-rays, aiming to optimise pre- clinical radiology learning.²

Method Two student groups, one using Chester and the other Radiopaedia, undertake a radiology quiz. The quiz will reflect diverse chest X-rays and will be used to compare diagnostic accuracy, efficiency, learning curve and reliability. Pre- and post-questionnaires, along with qualitative data from surveys and focus groups, will capture medical students' experiences and satisfaction levels.

Predicted results Anticipated findings include improved diagnostic accuracy and efficiency in the Chester group compared to the Radiopaedia group. Quantitative data will reveal insights into the learning curve associated with AI utilisation and its future in radiology education. Qualitative data will provide a nuanced understanding of medical student experiences, shedding light on preferences, challenges and satisfaction with AI-assisted learning.

Discussion Explore the anticipated benefits and challenges of integrating AI into medical education, contributing insights to the literature on AI in radiology. Ethical considerations, implications for future medical education and study limitations will guide directions for further research.

Keywords: artificial intelligence; OSCEs; pre-clinical; radiology; TEL

References

1. Sajid H. AI in radiology: pros & cons, applications, and 4 examples, V7 website. 2022. Available from: https://www.v7labs.com/blog/ai-in-radiology

2. Tejani, A. S., Elhalawani H., Moy L., Kohli M., Kahn CE Jr (2023) ‘Artificial intelligence and radiology education’, Radiology: Artificial Intelligence, 5(1). doi: https://doi.org/10.1148/ryai.220084

Lujain Alsadder, Usman Naeem, Matthew Simmons, Graeme Hathaway, Amir Hakim and Pedro Elston

Queen Mary University of London

Background Virtual learning environment (VLE) asynchronous interactive pre-sessional resources were designed to maximise students' learning and experience during laboratory sessions. This study aims to identify medical students' engagement with virtual pre-sessional resources and investigate the relationship between engagement with these resources and student's performance in the summative end-of-second-year data interpretation (DI) exam using Learner Engagement Analytics (LEA).^1,2

Methods A retrospective observational study was designed using VLE data at Queen Mary University of London. We defined ‘engagement’ markers as virtual resources used for asynchronous learning. These markers included H5P (HTML 5 Package) content, quizzes and other interactive materials that students completed before their practical sessions with activity completion records. The ‘engagement’ markers were used to calculate an average engagement score for each student. The relationship between students' results in their summative DI exam and engagement scores was measured using Pearson's correlation coefficient using Microsoft Excel.

Results The VLE dataset for LEA included data about 408 second-year medical students' interaction with virtual ‘engagement’ markers. The study identified 31 ‘engagement’ markers for laboratory pre-sessional resources. The cohort's total engagement score was 31% (SEM = 1.15%), and the DI exam average mark was 67.2%. There was a weak but positive relationship between students' engagement scores and their performance in the DI exam (Pearson's coefficient = 0.32). The key finding was that medical students who an engagement score >60% did not fail the DI exam. While we cannot attribute cause and effect, this highlights the ease with which LEA enables insights into medical learners' engagement.

Keywords: education; laboratory teaching; learner engagement analytics; medical; virtual learning environment

References

1. Naeem U, Bosman L. Learner engagement analytics in a Hybrid learning environment. 2023; 1–7.

2. Bojic I, Mammadova M, Ang CS, Teo WL, Diordieva C, Pienkowska A, Gašević D, Car J Empowering health care education through learning analytics: in-depth scoping review. J Med Internet Res 2023;25:e41671

Iyad Elkhuffash and David Hettle

North Bristol Academy, North Bristol NHS Trust

Background The potential of large language models (LLMs), a form of text-based artificial intelligence (AI), in medical education is vast. Text-based e-consults are increasingly used in medical practice worldwide.¹ From a learning perspective, interviews found doctors who use text-based consultations develop skills in language, reflection and identifying patient expectations.² Yet, little focus is placed on developing text-based consultation skills throughout medical training. Therefore, this project aimed to explore LLMs' utility in training medical students in text-based consultations, comparing multiple free-to-access LLMs to guide training strategies.

Methods After trialling sample scenarios through three LLMs, namely, ChatGPT 3.5®, CharacterAI® and Inworld AI®, stark differences were noted. In the absence of clear guidance on utilising AI for undergraduate learning, we developed a novel framework to interrogate the utility of LLMs in learning through text-based simulations to support curriculum developers and trainers.

Results The framework draws from the input-processing-output model in computing while incorporating the suggested human assessment criteria for evaluating LLMs.³ It includes LLMs' responses to inputs provided, their accessibility, outputs, how well they reflect provided information (i.e. clinical scenarios) and their realism in mimicking human conversation.

Next steps involve medical students using our framework to evaluate their interaction with these LLMs, data collection for which is ongoing and will be presented at the ASM.

Conclusion With AI's increasing importance in medical practice, strong assessment principles and techniques to equip undergraduate trainers are crucial. Our work considers the utility of current free-to-access LLMs to guide curriculum planners and medical schools in this novel technique.

Keywords: AI; e-consults; framework; large language models; medical students

References

1. Li B, Skoropad T, Seth P, Jain M, Truong K, Mariakakis A. Constraints and workarounds to support clinical consultations in synchronous text-based platforms. In: Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems. ACM; 2023:1–17. https://doi.org/10.1145/3544548.3581014

2. Björk AB, Hillborg H, Augutis M, Umefjord G. Evolving techniques in text-based medical consultation – physicians' long-term experiences at an ask the doctor service. Int J Med Inform 2017;105:83–88. https://doi.org/10.1016/j.ijmedinf.2017.05.013

3. Chang Y, Wang X, Wang J, et al. A survey on evaluation of large language models. Published online 28 December 2023. Accessed 22 Jan 2024. http://arxiv.org/abs/2307.03109

Jonathan Loomes-Vrdoljak and Lavin Assad

Royal Devon University Healthcare NHS Foundation Trust

Virtual simulated patients (VSPs) offer students the chance to develop clinical reasoning skills. However, to date, VSPs have relied on fixed or anticipated prompts in order for students to take a history.^1,2 ChatGPT is an AI-powered large language model capable of using conversational language and responding to it in a context-specific manner. As such, a ChatGPT-powered VSP should allow students to ask questions in their own way and simultaneously practise their history-taking and clinical reasoning skills.

We developed ChatGPT-powered VSPs as part of a project to evaluate student opinions of these as educational tools. In doing so, we discovered some idiosyncrasies in ChatGPT's behaviour. Through a process of trial and error and iterative development, we were able to design prompts that mitigated peculiar responses, limited the amount of information shared without being asked and taught it when to share specific parts of a history.

In this talk, we will describe how we engineered prompts for VSPs in ChatGPT and share advice for how to write your own VSPs, avoiding some of the pitfalls we came across. We also discuss alternative ways of interacting with virtual patients on ChatGPT, the costs of these and ways ChatGPT could be trained in the future to produce more realistic responses. While integrating ChatGPT into existing teaching platforms will require programming expertise, turning a script for a VSP into a prompt for ChatGPT is simple once you know a few key points.

Keywords: AI; education; medical

References

1. Nader Raafat, Harbourne AD, Radia K, Woodman M, Swales C, Saunders K. Virtual patients improve history-taking competence and confidence in medical students. Med Teach. 2023;1–7. https://doi.org/10.1080/0142159x.2023.2273782

2. Stevens A, Hernandez J, Johnsen K, Dickerson R., Raij A., Harrison C., DiPietro M., Allen B., Ferdig R., Foti S., Jackson J., Shin M., Cendan J., Watson R., Duerson M., Lok B., Cohen M., Wagner P., Lind D.S. The use of virtual patients to teach medical students history taking and communication skills. Am J Surg 2006;191(6):806–811. https://doi.org/10.1016/j.amjsurg.2006.03.002

Gwyndaf Roberts, Gemma Mitchelson, Sophie Hill, Sonia Bussey, David Thewlis, Emma Black and Bryan Burford

Newcastle University

Background Students need to feel a sense of belonging or connectedness to thrive in the online study environment, and for distance learning programmes, it is the discussion forum that offers the opportunity to establish an asynchronous learning community.^1,2 Our programme is predominantly delivered online but relatively few of our part-time postgraduate students participate in the discussion forums, and many that do tend to post stand-alone statements rather than interact with their peers. We wanted to explore approaches to improve both the number of interactions in the forums and the quality of the discussions, with the overall aim of developing students' engagement with the programme and each other.

Method One of our modules was delivered in three strands, allowing us to use three different approaches to organise the discussion forums: allocating students to specific groups; requiring a contribution to a forum before unlocking the next section; and allowing students to assign themselves to a group. Canvas' analytics provide the number of interactions with each forum, and programme staff evaluated the quality of interaction using a simple rubric. A student experience survey was conducted after each strand.

Results Early data show that simply allocating students to specific groups results in a small number of motivated individuals posting to the forums, with little interaction between the contributors. These students report a drop in motivation and frustration with their peers, leading to a feeling of isolation. We will present data on the effect of changing how students interact with online discussion forums.

Keywords: discussion; community; learning; online; postgraduate

References

1. Peacock S, Cowan J. Promoting sense of belonging in online learning communities of inquiry at accredited courses. Online Learn. 2019;23(2):67–81. https://doi.org/10.24059/olj.v23i2.1488

2. LaBarbera R. The relationship between students' perceived sense of connectedness to the instructor and satisfaction in online courses, Q Rev Distance Educ 2013;14(4):209–220.

Edward Armstrong, Louise Rogers, Mia Lyon and Joanne Selway

The University of Buckingham

Background There is a need to identify evidence-based strategies to maximise student engagement in online learning contexts. Audience response systems such as Mentimeter are established active learning tools that have not yet been fully evaluated in the online context.

Aim To directly compare student engagement, perceptions and learning in online teaching sessions using interaction driven by Mentimeter versus interaction using videoconferencing software (Microsoft [MS] Teams) alone.

Methods We designed a series of 11 online clinical anatomy revision sessions advertised to all undergraduate medical students at a UK university. Sessions were randomised to include interactive questions using Mentimeter or interactive questions using MS Teams functionality only. Attendance and engagement were monitored and evaluated, and attendees were asked to complete a post-session survey and end-of-session test of knowledge.

Results There was a total of 525 attendances across the programme. Mean engagement with interactive questions using Mentimeter was substantially higher compared to questions asked using MS Teams alone (30.1% versus 6.4%, p = 2.2 × 10⁻¹⁶)). When directly asked in the post-session survey, most students felt the use of Mentimeter improved engagement (90.3%), interest (94.9%), learning (94.9%) and testing of knowledge (93.3%). Students scored higher on the end-of-session test of knowledge following sessions using Mentimeter (6.6 versus 5.3, p = 0.007) and had a higher feedback response rate (24.6% versus 14.3%, p = 0.003).

Conclusions Mentimeter considerably improves student engagement in online revision sessions and is positively received by students.

Keywords: audience response systems; engagement; interactivity; Mentimeter; online learning

Andrew Callaway

County Durham and Darlington NHS Foundation Trust

Ask any of your medical students if they use Anki and they will answer that they either use it, have tried it or are thinking about trying it. Wondering what Anki is? Do not worry, you will not be alone. While we have been labouring under the misapprehension that the next technological advancement in medical education will be decided from the top downwards, the students have already chosen, without us.

Flashcards are nothing new as study skills go; however, when combined with powerful spaced repetition algorithms, ample portability and free open access, it should come as no surprise that students have widely adopted them into their study repertoire. Active recall, spaced repetition software (of which Anki is the leading name) is here to stay. This however raises many questions. Should we be incorporating this technology into our strategies for learning? What are the pitfalls of learning in this way? What will the future look like as the way we deliver and assess medical education evolves?

In this session, I will use my research as well as my experience as an educator and a learner who using these tools to inform the uninformed and start the discussion.

Keywords: digital flashcards; medical students; spaced repetition; technology

Miriam Leach

University College London

The Internet is now pervading most aspects of contemporary life. There are many complex and competing dialogues around the online social landscape in medical education. It is broadly thought of as affording many people a new feeling of freedom from traditional social hierarchies (Selwyn, 2011). This has been extrapolated by some to suggest an inevitable decline in the need for traditional educational institutions, as we see the rise of ‘anytime, anywhere’ freely, collaborative learning (Polin, 2010). Ellaway warns us of such ‘technological determinism’, reminding us that the online learning environment is both engineered and political and that quality may not be the main driver for its use (Ellaway, 2011).

Flexibility in education has long been lauded as both a value and a mechanism of learning to be prized. However, I argue here in this critical discourse analysis that this is a social concept that has been constructed, favouring and obstructing other discourses and key aspects of power relations. Critical discourse analysis is a relatively new, interdisciplinary methodology drawing on unique theoretical paradigms and lenses. My archive at the time of writing includes contemporary academic literature, conference abstracts and online social media articles. This is an ongoing dissertation project as part of masters in medical education, results and conclusions to follow.

Keywords: critical; learning; online; TEL

References

Ellaway, R. (2011) eMedical Teacher, 33(1), pp. 88–90

Polin, L. G. (2010) ‘Graduate professional education from a community of practice perspective. The role of social and technical networking’, Social learning systems and communities of practice, pp. 168–169, The Open University/Springer.

Selwyn, N. (2011) ‘Sociocultural theories of learning and technology‘, in publishing, B. (ed.) Education and technology: key issues and debates, pp. 76–78, A&C Black.

Andrew Walker, Charles James, Matthew Abraham and Chloe Anderton

University of Leeds

Background Educators have noted poor attendance at face-to-face lectures since the COVID-19 pandemic, with resultant concerns about student engagement. Reasons for poor lecture attendance are unclear. What do students think about how medicine is taught in 2024? Is a digital-first approach the answer?

Methods We audited student engagement for Year 1 MBChB gathering data for all 287 students. We developed novel resources to match the learning objectives in a number of lectures and offered students the chance to use these instead of, or as well as the existing material. We surveyed students for their views.

Results In a highly rated module (>97% positive feedback), mean face-to-face attendance was around 30%, 20% followed live on TEAMS, and just under 50% used lecture capture. Reflexive thematic analysis highlighted key themes from students. Students felt that watching the lecture capture rather than attending live gave greater flexibility, aided with accessibility (with closed captions) and fostered better time management. Moreover, students found watching lecture recordings allowed them to pause, rewind and look up related resources, fostering active-learning behaviours. Feedback from the novel bite-sized asynchronous resources was overwhelmingly positive with 100% positive feedback and more than 70% surveyed believing such resources could replace the traditional lecture altogether. Importantly, these resources were accessed more than any other form of delivery, including lecture capture.

We will encourage delegates to reflect on their own programmes, considering how they can deliver material flexibly to suit the digital generation. This strategy may help meet the challenges of the NHS workforce plan (1).

Keywords: blended; digital; student views; undergraduate; virtual

Reference

1. NHS long term workforce plan 2023. Available from: https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/

Robert Jay¹, Jeremy Brown², Emma Wilson³, Rakesh Patel⁴ and John Sandars²

¹Edge Hill University/University of Lincoln; ²Edge Hill University; ³University of Nottingham; ⁴Queen Mary University London

Background Self-regulated learning (SRL) interventions have been associated with improved performance in medical education,¹ especially for low-performing learners.² However, work is needed to explore how to most effectively introduce SRL training activities, as they are often unpopular. This study uses a mixed-methods approach to explore how embedding SRL activities within virtual patient clinical reasoning cases affects student engagement.

Methods Final year students at three UK medical schools undertook 10 virtual patient cases over 10 weeks. Students were randomly allocated to three groups: SRL prompts embedded within the cases; feedback on their SRL; and no SRL prompts. A purposive sample of participants was interviewed, and themes identified.

Results One hundred seventy-one students completed nearly 1000 cases over 10 weeks. Case completion fell across all groups over time, with over a third dropping out by the 10th case. The greatest decline occurred in those who received feedback on their SRL, but this was not statistically significant. Twenty per cent of students stopped engaging with the SRL activities by week 5, with nearly 40% disengaging by week 8. Qualitative themes identified included the time taken to complete activities and the feeling that the benefit of recording their SRL decreased over time.

Conclusions The findings highlight, as in SRL diary interventions,² the importance for educators to justify to learners the importance of engaging in SRL activities by providing appropriate guidance about its benefits. Our future research will identify the optimal minimum number of completed cases for developing SRL and improving clinical reasoning skills, especially for low-performing learners.

Keywords: clinical reasoning; self-regulated learning; virtual patients

References

1. Leggett H, Sandars J, Burns P. Helping students to improve their academic performance: a pilot study of a workbook with self-monitoring exercises. Med Teach 2012;34(9):751–753.

2. Zarei Hajiabadi Z, Gandomkar R, Sohrabpour AA, Sandars J. Developing low-achieving medical students' self-regulated learning using a combined learning diary and explicit training intervention. Med Teach 2023;45(5):475–484.

Daniel Magee¹, Georgina Cooper¹ and Tomas Ferreira²

¹Keele University; ²University of Cambridge

Objective To determine current Keele medical students' career intentions post-graduation and upon completing the foundation programme (FP) and to ascertain the motivations behind these intentions.

Design Cross-sectional survey of 228 medical students at Keele Medical School.

Results In total, 228 responses were collected from medical students at Keele Medical School, accounting for 29.42% of the total student population (228/775). The majority of students (197/228, 86.40%), planned to complete both Foundation Year 1 (FY1) and Foundation Year 2 (FY2) after graduation, with 51.27% of these students (101/197) intending to pursue specialty training thereafter. Subanalysis of career intentions after completion of FY2 by current year of study revealed a sizeable decrease in the proportion of students intending to enter specialty training as they progressed in their medical studies. Nearly a third of medical students intended to emigrate to practise medicine (66/228, 28.95%), with 48.48% of those students having no plans to return to the United Kingdom. 2.19% of medical students intended to leave the profession altogether. In total, 31.14% of students intend to leave the NHS within 2 years of graduating.

Conclusions The results of the AIMS (Ascertaining the career Intentions of UK Medical Students) study shed light on the career intentions and views of medical students in the United Kingdom. The findings suggest that a concerning proportion of Keele medical students are considering alternative career paths or intending to emigrate to practise medicine elsewhere after graduation. This trend may have implications for the future of the medical profession within the United Kingdom.

Keywords: career intent; doctor, medical training; NHS; workforce planning

Rohin Athavale, Sarah Allsop, James Lepoittevin, Jane Williams and Daisy Hewitt

University of Bristol

Background Teaching skills are often developed at medical school, benefitting students by helping them consolidate their knowledge and providing meaningful feedback to peers [1, 2]. At Bristol Medical School, there are multiple schemes where students teach their peers, the challenge is how best to record this.

We developed a ‘teaching log’ form to allow students to record their teaching activities in their ePortfolio through first reflecting on their teaching and then requesting feedback from another student or staff.

Methods To evaluate the teaching log's design and implementation, an analysis of 54 students' ePortfolio metadata was performed alongside a survey of a selection of students using the form (UoB Ethics: 12392).

Results Metadata analysis shows peer teaching occurs in a variety of settings, for example, basic life support, OSCE skills and bedside teaching. Seventy-two per cent students engaged with both reflective and feedback elements of the form.

Preliminary survey results showed positive feedback—‘The form layout is straightforward … the prompt questions are good…’—and suggests it promotes learning: ‘It guides the user to reaching learning points for the future’. Eighty-three per cent of students would use the form again, and 67% would recommend it to peers.

Conclusion Many students engage in peer teaching activities and need the opportunity to reflect and gain feedback on these experiences. Our online teaching log facilitates this in a user-friendly way embedded within the student ePortfolio. We continue to evaluate the form's use and aim to conduct follow-up interviews with survey participants in future to gain greater insight into student teaching.

Keywords: peer feedback; peer teaching; self-reflection; undergraduate

References

1. Kassab SE, Abu-Hijleh MF, Al-Shboul Q, Hamdy H. Student-led tutorials in problem-based learning: educational outcomes and students' perceptions. Med Teach 2005;27(6):521–526. https://doi.org/10.1080/01421590500156186

2. Peets AD, Coderre S, Wright B, Jenkins D, Burak K, Leskosky S, McLaughlin K. Involvement in teaching improves learning in medical students: a randomized cross-over study. BMC Med Educ 2009;9(1):55. https://doi.org/10.1186/1472-6920-9-55

Kathleen Thompson, Nicholas Rossi, Beth Jones, Meera Kattakayam and Aisling Kelly

Bradford Teaching Hospitals NHS Foundation Trust

Clinical staff are under increasing pressure in the NHS and the rate of staff ‘burn out’ is at an all time high.^1,2 Often, undergraduate medical education (UGME) teams in hospital sites are based away from clinical areas. For clinical staff, it can feel like there is a divide between themselves and UGME teams. This results in already stretched clinical staff viewing teaching as an additional workload burden, leading to feelings of dissatisfaction from students who feel they are not included or welcome.

At Bradford Teaching Hospitals, 43% of clinical staff felt they were uncomfortable balancing clinical duties with their teaching responsibilities, and 31% felt they were not able to provide the level of education they aspired to. Twenty-five per cent of staff felt uncomfortable with the number of students on a ward round, and this was reflected within student feedback where 16% of students felt both excluded from ward round and felt clinical staff were not able to give enough time towards teaching.

An ‘Inreach’ programme was designed to improve satisfaction for both students and clinical staff by enhancing the clinical teaching experience. This was done by linking a member of the UGME team to a clinical area, providing support for students and staff and reducing the teaching burden placed on clinical colleagues.

With the NHS workforce plan³ projecting a significant increase in student numbers, it is essential we think about how we can support existing clinical teams/environments within placement providers to facilitate the impending increase in learner numbers.

Keywords: burden; burnout; Inreach; gap; undergraduate

References

1. Deakin M. NHS workforce shortages and staff burnout are taking a toll. BMJ 2022;377(1):945. https://doi.org/10.1136/bmj.o945

2. Kohler D. NHS staff wellbeing has already been weaponised. BMJ 2023;381:p1128. https://doi.org/10.1136/bmj.p1128

3. NHS England. NHS England» NHS long term workforce plan. england.nhs.uk. Published 30 June 2023. https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/

Dafydd Morgan¹ and Paul Grant²

¹Great Western Hospital; ²University of South Wales in association with Learna Diploma MSc

Background Confidence in dermatological examination worldwide is arguably low among medical students. The amount of undergraduate medical curriculum time devoted to dermatology teaching has been traditionally relatively low. The COVID-19 pandemic fuelled significant changes in dermatology clinical practice (such as the move to online consultations), which has reduced student exposure to patients in person as a consequence. Given these challenges, using moulage (detailed make up) to recreate skin lesions to assess students could be a viable option to assess students.

Methods A scoping review was conducted in accordance with the Joanne Briggs Institute methodology. The literature search was performed using the following databases: PubMed, Scopus, CINAHL, Web of Science and EMBASE. Articles were selected against clear inclusion and exclusion criteria.

Results Of the 3823 articles found, 11 met the inclusion criteria, with nine of the 11 studies examining the role of moulage in medical assessments. The studies included a mix of qualitative and quantitative data. All of the studies included in this scoping review have demonstrated that using moulage is effective and acceptable as an assessment modality in dermatology undergraduate medical education.

Conclusion Using moulage to examine medical undergraduate students in the field of dermatology is a viable assessment method and could be utilised if further global health crises arise in the future. Further larger, better powered studies are required to more confidently generalise these findings; however, it is recommended that medical schools explore the utility of such approaches to help improve the scope and depth of dermatology education.

Keywords: assessment; dermatology; education; review; undergraduate

References

1. Choi, B., Jegatheeswaran, L., Minocha, A., 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: pp.1–11.

2. Jones V.A., Clark K.A., Puyana C., and Tsoukas M.M. (2021) Rescuing medical education in times of COVID-19. Clin Dermatol; 39(1): pp.33–40.

3. Stokes-Parish, J.B., Duvivier, R., and Jolly, B. (2018) Investigating the impact of moulage on simulation engagement—a systematic review. Nurse Educ Today; 64: pp.49–55.

Madeline Izza, Andrew Westripp, Caitlin O'Donovan, Thomas Shackshaft, Robert Flather, Elizabeth Tighe, Alice Evans, Rachel Nigriello and Amy Baker

University of Bristol

Background The General Medical Council stipulate that doctors must assist in both in-hospital and out-of-hospital medical emergencies and manage the associated uncertainty.¹ Transitioning from medical student to doctor evokes a range of emotions including lack of confidence around non-technical skills.² Simulation has been widely adopted within medical education, giving students experience of emergency situations without risking patient safety. Simulation scenarios improve student awareness of non-technical skills, as well as improving confidence in dealing with emergencies.³ We have chosen to investigate whether learning from a different perspective could address common issues, such as working in unfamiliar teams and challenging environments.

Methods A combination of aeroplane-based simulation scenarios and complementary workshops looking at medical emergencies in a non-healthcare environment will be delivered to final year medical students, with a focus on transferable skills used in managing non-technical factors encountered. Debriefs and Likert-scale questionnaires will be completed before and after the simulation day to provide themes for focus group discussion. These semi-structured group interviews will discuss the impact of and learning from the simulation day. Questionnaire data will be analysed to assess if a statistically significant change has been observed in student perceptions. Thematic analysis of focus group discussions will be completed to contextualise the quantitative findings.

Results Pending at time of submission.

Discussion We will consider strengths and limitations of this innovative simulation teaching day, reflecting on the potential benefits of this non-healthcare setting for final year medical students in developing transferrable non-technical skills given their imminent transition to postgraduate practice.

Keywords: medical emergency; medical students; non-healthcare setting; non-technical factors; simulation

References

1. General Medical Council. Good Medical Practice. General Medical Council. 29 April 2019. Accessed 18 Jan 2024. https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice/

2. Berridge, E.-J., Freeth, D., Sharpe, J. and Roberts, C. M. Bridging the gap: supporting the transition from medical student to practising doctor - a two- week preparation programme after graduation. Med Teach 2007;29(2–3)119–127. https://doi.org/10.1080/01421590701310897

3. Watmough, S., Box, H., Bennett, N., Stewart, A. and Farrell, M. Unexpected medical undergraduate simulation training (UMUST): can unexpected medical simulation scenarios help prepare medical students for the transition to foundation year doctor? BMC Med Educ 2016;16(110). https://doi.org/10.1186/s12909-016-0629-x

Hugh Alberti and Ahmad Hisham Wafai

Newcastle University

Background Students on the MBBS program at Newcastle University have access to a ‘raising a concern’ process. Concerns may be raised about staff, clinicians or other students and can reflect a variety of concerns. Approximately 30–50 concerns are reported via this process every year; however, there are anecdotal reports of lack of clarity and relevant experiences going unreported.

Aim To explore students' views and concerns about the raising a concern process and garner suggestions to improve the process.

Methods We undertook a mixed methods analysis of the process to assess students' views. An anonymised questionnaire survey was sent to all MBBS students followed by an online focus group to further explore students' views.

Results Eighty students responded to the survey. Eighty per cent of respondents were aware of the process, but only 2/3 knew how to access it. 1/3 had witnessed a concern, and 1/4 had experienced concerning behaviour. Most students would feel uncomfortable submitting a concern via the formal process but comfortable raising it with their academic mentor. Barriers to raising a concern included previous bad experiences, fears of repercussions for themselves and a lack of awareness of the process. Focus group participants described the process as ‘murky’ with a lack of transparency around who the investigators were, confidentiality and timescales. They also raised the question of when and where to raise concerns.

Conclusions Our study revealed a number of concerns that students have regarding our ‘raising a concern’ process that have led to a number of changes in our process.

Keywords: concerns; undergraduate

Emma Lewin, Yuri Aung, Sherene Howard-Walker and Nadia Osman

Barts Health NHS Trust

Background Medical professionals face challenges similar to those in high-stakes performing careers, requiring adaptability and improvisation. Despite the proven benefits of pre-performance routines (PPRs), for example, task visualisation and breathing exercises, in other fields,¹ their impact on medical practice among undergraduates remains understudied. This project aimed to explore the influence of PPRs on medical student performances, investigating whether they lead to improved outcomes or personal experiences.

Methods During an online lecture, students were introduced to PPRs and encouraged to develop their own, considering potential applications. Subsequently, students had the opportunity to incorporate a PPR into a high-fidelity simulation scenario. Anonymous questionnaires, completed before and after the simulation, assessed students' confidence levels, PPR usage and perceived impact on performance.

Results Out of 38 students, 21 (55.3%) utilised PPRs during the simulation. Visualisation (71.4%), positive self-talk (33.3%) and mindfulness/breathing techniques (33.3%) were common techniques. Students employing PPRs showed a mean confidence increase from 6.24 to 7.76/10 following the session, compared to 6 to 7.29/10 for those who did not, though not statistically significant (p = 0.44). Among PPR users, 81.0% agreed it improved performance, and 76.2% felt it helped manage nerves. Qualitative responses provided insights into potential uses, advantages and disadvantages of PPRs, as well as factors influencing their adoption.

Conclusion This pilot demonstrates the potential for PPRs to improve medical student experience in pressurised situations for those who choose to use them. Further research, encompassing diverse settings and a larger student population, is required to further evaluate the scope and impact of PPR use.

Keywords: OSCE; performance; simulation; undergraduate

Reference

1. Cotterill, Stewart. (2014). Preparing for performance: strategies adopted across performance domains. Sport Psychol 29. https://doi.org/10.1123/tsp.2014-0035.

Sarah Gaffing, Peace Chima and Hugh Alberti

Newcastle University

Background Newcastle University Medical School has recently undergone radical change in curriculum design including a compulsory longitudinal clerkship for fourth year students and an apprenticeship for fifth year after finals. This study aimed to explore the impact of these changes and in particular: Have the curriculum changes better prepared our graduates for work and enabled an easier transition into the foundation programme? And if so, how?

Methods The study used a mixed-methods approach. Questions were added to the Northern Regions foundation doctors ‘Your school your say’ survey and data collected for our graduates; responses were separated between graduates who had undergone the previous and current curricula. In addition, focus groups were undertaken with foundation doctors to explore their experiences; transcripts were thematically analysed.

Results There were 198 survey respondents; 122 had undergone the old curriculum, and 76 had undergone the new curriculum. There were very few differences in responses between graduates of the previous and current curricula; exceptions were new curricula graduates felt better prepared for undifferentiated problems and less likely to want to see changes to assistantships: however, they felt less prepared to work in teams.

Three focus groups of 12 participants discussed a variety of themes including preparedness for practice (noting the assistantships as being particularly helpful), clinical experience (being dependent on their clinical attachment), specialist knowledge input (too much) and the impact of Covid-19.

Conclusions Our study has revealed a number of interesting findings that will enable continued refinement of our, and potentially other, medical school curricula.

Keywords: curricula; preparedness; undergraduate

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 In 2023, UKFPO implemented removal of deciles for all foundation programmes including SFP, causing an overhaul of the competitive selection process.¹ There still remains inadequate institutional support for applicants from final year medical students,² so targeted webinars provide support for prospective trainees.

Methods A nine-part free webinar series, directly mapped to the application timeline from July to November 2023, was delivered by eight SFP (FY1) doctors across England using MedAll, an online education platform. Sessions included overview of academic tracks, application process with key changes, white space questions (WSQ) and interview preparation. Recordings were available open-access and an additional free WSQ reviewing service.

Live attendees provided feedback through questionnaires and data analysed with Microsoft Excel.

Results Over 5 months, 222 attended live, with a 43% feedback rate, plus 16 (7%) accessed the WSQ service. On average, there was a 37% increase in the baseline understanding of the SFP across sessions, with the highest improvement in ‘Intro to SFP’ session (45.8%). The main themes identified from qualitative data suggested that sessions were ‘useful’, ‘informative’ and ‘concise’ with ‘great examples’ and ‘good interaction’. No significant differences in feedback among speakers were noted.

Discussion Our series provided an engaging, near-peer learning experience with detailed SFP application advice including live Q&A. The majority of our viewers accessed our learning materials after sessions were held, highlighting the significance of quality open-access material to promote accessibility to the SFP. Future cycles should expand free personalised services alongside webinars for optimal support.

Keywords: accessibility; medical students; online; specialised foundation programme

References

1. UK Foundation Programme (UKFPO). UKFP 2024 Key Changes. Published 17 July 2023. Accessed 22 Jan 2024. https://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/eligibility-information/ukfp-2024-key-changes/

2. Salem J, Robertson S, Paul N, Balagamage A, Awan H. Differential attainment within the Specialised Foundation Programme: creating an accessible mentorship scheme to increase diversity within academic medicine. Cureus 2023;15(10):e47700. https://doi.org/10.7759/cureus.47700

Amelia Scholes, Aasiya Chaka, Emma Spowart, Thomas Oliphant, Simon Meggitt and James Fisher

Newcastle University

Background Early clinical experience (ECE) is recognised to be valuable for medical students¹ and has been adopted widely.² However, in the United Kingdom, expanding numbers of health professional students has made clinical environments increasingly crowded, making the provision of ECE challenging. Providing ECE remotely, using technological solutions, may supplement existing in-person ECE. We aimed to answer the following research questions: Is provision of ECE by live-streamed clinics feasible? Is students' knowledge enhanced by virtual ECE? We defined ECE as ‘authentic human contact in a social or clinical context that enhances learning of health, illness or disease and the role of the health professional’.³

Methods Ethical approval was obtained from Newcastle University's Research Management Group. Two 120-min sessions will be delivered to early-stage medical students on 13/02/24 and 27/02/24. A successful pilot session has already been undertaken as a proof of concept. An in-clinic clinician will undertake clinical assessment of three patients. Consultations will be live-streamed to the classroom. The clinical topics (ophthalmology and dermatology) were selected as their visual nature was considered well suited to the model of delivery. An in-class clinician will facilitate discussion among learners in between consultations. To assess the educational value, students will complete pre- and post-session knowledge assessments mapped to our local curriculum. To explore feasibility, students will be surveyed (using both Likert scale and free-text questions) and will draw on reflections from the educators involved.

Results Data and our findings will be presented at the ASM.

Keywords: consultation; education; live; undergraduate; 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):740–746. DOI: https://doi.org/10.3109/0142159X.2010.496007.

2. Simmenroth A, Harding A, Vallersnes OM, Dowek A, Carelli F, Kiknadze N, Karppinen H Early clinical exposure in undergraduate medical education: a questionnaire survey of 30 European countries. Med Teach 2023;45(4):426–432. DOI: https://doi.org/10.1080/0142159X.2022.2137014.

3. Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. BMJ 2005;331(7513):387–391. https://doi.org/10.1136/bmj.331.7513.387.

Hamza Ikhlaq¹, Gemma Lewis² and Tilo Scheel²

¹Imperial College London; ²Trent Meadows Medical Practice

Background Depression and anxiety are among the leading causes of illness and disability among adolescents, with research highlighting structural weaknesses in mental health services.^1,2 Within our GP practice, we noticed an increased number of adolescent mental health consultations; however, limited management options exist.

Therefore, we aimed to evaluate what alternative support and resources are available, how accessible these are and whether they meet the needs of adolescents with mental health difficulties.

Methods We used a needs and assets approach to analyse existing resources, their accessibility and utility within the local community. Perspectives of community-based stakeholders including practice staff, local sports club staff and teachers at a local secondary school were obtained in multiple feedback forums.

Results We found few ‘self-help’ resources available for adolescents. Stakeholders reported that information relating to currently available services was overwhelming and difficult to navigate.

We therefore created two digital information summaries containing self-help resources and signposting to local services and shared these for review by our stakeholders. Feedback included that these resources were engaging and allowed for a more empowering, proactive approach to mental health.

Conclusion Utilising a community-based approach to evaluating current resource provision for adolescents with mental health difficulties was effective to gain valuable stakeholder perspectives that informed the development of sustainable and cost-effective resources. Integration of these resources into the practice webpage and online consultation systems is planned with feedback by service users.

Keywords: community engagement; primary care; QIP; well-being.

References

1. Mental health of adolescents. World Health Organization. Accessed: 19 October 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

2. Hinrichs, S., Owens M., Dunn V., Goodyer I. (2012) ‘General practitioner experience and perception of child and adolescent mental health services (CAMHS) care pathways: a multimethod research study’, BMJ Open, 2(6). https://doi.org/10.1136/bmjopen-2012-001573

Holly Christopher, Kelsie Sykes and Helen Barker

NHS England East of England

Background Healthcare professionals, including trainees, are increasingly at risk of burnout, a term used to describe exhaustion and a lack of motivation and engagement, often in the context of a demanding job. Feelings of imposter syndrome, the belief of lacking competence despite evidence to the contrary, can also be seen in trainees. Imposter syndrome is associated with higher rates of burnout.¹ Progress towards tailoring training to the individual has to be considered in the context of increasing demand on trainers in resource-scarce settings. Simple tools that could target support to those most at risk from burnout may aid resource allocation and improve well-being.

Methods A survey administered by NHS England East of England to gain insight into foundation trainee experiences was fully completed by 22 trainees at three training sites. It included optional questions using the Oldenburg Burnout Inventory² and Leary Imposterism Scale.³

Results The mean burnout score was 41/64 (ranged from 26 to 53), and 18 out of 22 trainees ‘agreed’ or ‘strongly agreed’ with the statement ‘after my work, I usually feel worn out and weary’. The mean imposterism score was 13/35 (ranged from 7 to 26). Of interest, all five of the highest scoring trainees for imposterism had a burnout score of 45 or more. This highlights the potential overlap of imposterism and burnout and suggests a 7-point imposterism scale³ could be used to predict need for support and target delivery of well-being resources in foundation trainees.

Keywords: burnout; foundation trainees; imposter syndrome; well-being

References

1. Gottlieb M, Chung A, Battaglioli N, Sebok-Syer SS, Kalantari A. Impostor syndrome among physicians and physicians in training: a scoping review. Med Educ 2020;54(2):116–124. https://doi.org/10.1111/medu.13956

2. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol 2001;86(3):499–512, https://doi.org/10.1037/0021-9010.86.3.499.

3. Leary MR, Patton KM, Orlando AE, Funk WW. The impostor phenomenon: self-perceptions, reflected appraisals, and interpersonal strategies. J Pers 2000;68(4):725–756. https://doi.org/10.1111/1467-6494.00114

Lisa Gould

UCL

Background Healthcare workers (HCWs) are increased risk for anxiety, depression, burnout, insomnia, moral distress and post-traumatic stress disorder (Bakhamis et al., 2019; Friganoviü et al., 2019; Hall et al., 2016). This study provides an in-depth exploration of fully anonymised concerns that HCWs, including students, expressed in real time to a mental health crisis text line. It explores areas of concern for HCWs, in their own words and from conversational analysis that are relevant to health education, student health and well-being.

Methods We analysed data from ‘Shout’, a UK-wide mental health crisis text message support service specifically for HCWs. Purposive sampling of scripts of 60 conversations between HCWs and ‘Shout’ service providers from April 2020 to March 2021 was undertaken, with data fully anonymised by ‘Shout’. The conversations were coded to develop a thematic framework and analysed using grounded theory.

Results Three themes emerged from the data: poor mental health, negative work experiences and the impact of the pandemic in workplace safety and risk. We identified that certain subgroups of HCWs, including those with pre-existing mental health problems and doctors, presented with more frequent or more severe crisis. Furthermore, we identified organisational stressors that may contribute to poor mental health in times of challenging service provision. Educational institutions supporting students working within the NHS can use this collection of narratives to inform mental health service provision and assess risk for students during placements and NHS-based training.

Keywords: mental health; NHS; well-being; workplace learning

References

Bakhamis, L., Paul, D. P., Smith, H., & Coustasse, A. (2019). Still an epidemic: the burnout syndrome in hospital registered nurses. Health Care Manag, 38(1).

Friganoviü, A., Seliþ, P., Iliü, B., & Sediü, B. (2019). Stress and burnout syndrome and their associations with coping and job satisfaction in critical care nurses: a literature review. In Psychiatr Danub (Vol. 31).

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O'Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS ONE, 11(7), e0159015.