1
|
Houlden R, Crichton F. Want doctors to use VR simulation? Make it mandatory, accessible, educationally valuable, and enjoyable! MEDEDPUBLISH 2024; 14:8. [PMID: 38932994 PMCID: PMC11200059 DOI: 10.12688/mep.20040.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background Virtual reality (VR) simulation training is mandatory for postgraduate year 1-2 doctors at the author's hospital trust. Despite this, a preceding quantitative study demonstrated uptake below required levels. While the educational value of VR simulation has been highlighted, little attention has been paid to participant utilisation in postgraduate curricula. With the increasing development and incorporation of VR-based clinical education, it is essential to understand the factors influencing how frequently postgraduate doctors utilise it so that its potential can be maximised. Methods A qualitative study design was employed. All 108 postgraduate year 1-2 doctors from the 2020-21 training year were invited for a semi-structured interview. Interviews continued until data saturation was reached in the form of informational redundancy. Reflexive thematic analysis was conducted. Results A total of 17 interviews were conducted. Four main themes that influenced participation in VR simulation were identified: (1) the mandatory nature encouraged participation but led to negative perceptions as a tick-box exercise; (2) there were multiple challenges to accessing the resource; (3) the scenarios were felt to have limited educational value; and (4) there was untapped potential in drawing benefits from VR as an enjoyable leisure activity. Conclusions Recommendations from these findings include: (1) VR simulation should be mandatory but with a degree of learner autonomy; (2) sessions should be integrated into doctors' rotas as protected time; (3) more challenging scenarios ought to be created aligned with postgraduate courses, examinations, and specialty training, and (4) presented as a difficulty level system akin to gaming experiences.
Collapse
Affiliation(s)
- Riki Houlden
- University of Dundee, Dundee, Scotland, UK
- East and North Hertfordshire NHS Trust, Stevenage, England, UK
| | | |
Collapse
|
2
|
Aggarwal M, Abdelhalim R, Fowler N, Oandasan I. Conceptualizing "Preparedness for Practice": Perspectives of Early-Career Family Physicians. Fam Med 2023; 55:667-676. [PMID: 37643091 PMCID: PMC10741718 DOI: 10.22454/fammed.2023.294689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Competency based medical education (CBME) aims to produce graduates prepared for independent practice. Many equate the outcome of "preparedness for practice" with acquisition of competence. As educators evaluate the outcomes of CBME, being clear on the concept of preparedness for practice will clarify the results that are measured and assessed. This study examined how preparedness for practice is conceptualized in the literature and by family physicians (FPs) in Canada. METHODS This multimethod qualitative descriptive study included (1) rapid review and narrative synthesis, and (2) focus groups with early-career FPs using maximum variation sampling until thematic saturation was reached. Focus groups explored the FPs' conceptualizations of preparedness for practice. Focus groups were audio-recorded, transcribed, and coded before content analysis. RESULTS Thirty-four articles met the inclusion criteria, and 59 early-career FPs participated in the focus groups. We found no consensus on the conceptualization of preparedness for practice in the literature; however, the concept often was described as acquiring competencies for program requirements. In the literature and focus groups, we identified four themes for the conceptualization of preparedness for practice. These themes included competence, self-confidence (self-efficacy, self-concept), capability, and adaptability. CONCLUSIONS Preparedness for practice involves an interplay of dynamic and complex constructs from competence, self-confidence, capability, and adaptability. Preparedness is more than possessing several competencies; it calls for integrating and applying competencies in complex and changing environments. This study aimed to start a discussion on what end point is desirable for residency education and proposed that the end point needs to move beyond competencies.
Collapse
Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of TorontoToronto, ONCanada
| | - Reham Abdelhalim
- Institute of Health Policy, Management and Evaluation, University of TorontoToronto, ONCanada
| | - Nancy Fowler
- Department of Family Medicine, McMaster UniversityHamilton, ONCanada
| | - Ivy Oandasan
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
| |
Collapse
|
3
|
Alexander EC, Vaidya HJ, Burford C, Mansfield R. Teaching in Paediatrics for UK Foundation Doctors: A Cross-Sectional Study. Cureus 2023; 15:e47714. [PMID: 38021519 PMCID: PMC10676225 DOI: 10.7759/cureus.47714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Most doctors will care for children regularly during their careers in settings such as the emergency department, general practice, surgery, or, for a minority, during paediatric specialist training. As such, exposure to topics related to child health ought to be part of the broad curriculum of learning offered to UK Foundation Programme doctors. Objective This study aimed to quantify teaching in paediatrics that is accessed by Foundation doctors. Methods A cross-sectional electronic survey of foundation year one or two (F1/F2) doctors at the end of the 2020-2021 academic year. Ethical approval was granted by the Imperial College London (ICL) Education Ethics Review Process (EERP 2021-082). Results Two-hundred and five Foundation doctors completed the survey, from 16 of the 18 Foundation schools. Respondents attended a median of two hours (interquartile range (IQR) 0-10) of paediatric teaching during the past 12 months, including a median of one hour (IQR 0-2) of core teaching and a median of one hour (IQR 0-9) of non-core teaching. Those who had worked in a paediatric post in the past 12 months, or who were interested in Paediatrics as a career, attended more median hours of teaching. Conclusions Although many doctors will care for children routinely during their later careers, the number of teaching hours in paediatrics experienced by Foundation doctors is low. The UK Foundation Programme should incorporate more teaching in paediatrics to increase exposure to child health amongst newly graduated and as-yet unspecialised doctors.
Collapse
Affiliation(s)
| | | | - Charlotte Burford
- Surgery, East Kent Hospitals University NHS Foundation Trust, London, GBR
| | | |
Collapse
|
4
|
Irie N, Morijiri Y, Yoshie M. Symptoms of and coping strategies for music performance anxiety through different time periods. Front Psychol 2023; 14:1138922. [PMID: 37325759 PMCID: PMC10264607 DOI: 10.3389/fpsyg.2023.1138922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/21/2023] [Indexed: 06/17/2023] Open
Abstract
Music performance anxiety (MPA) manifests itself at mental, physiological, and behavioral levels. The present study investigated how the experience of the three levels of symptoms changes over time, and how musicians cope with these temporal changes in MPA symptoms. To this end, we conducted a questionnaire survey in which 38 student musicians freely commented on their experiences of mental and physical changes, as well as their coping strategies for these changes. This was examined during five different time periods around public performance, extending from the beginning of the preparation for a public performance until shortly before the next public performance. The free-text comments obtained from the questionnaire were analyzed thematically and classified into different response themes. We then examined the temporal changes in the frequency of comments on each response theme. We further conducted a semi-structured interview involving eight musicians to explore the responses to the questionnaire in greater detail. We analyzed the contents of the free-text comments obtained from the questionnaire and the interview for each response theme, focusing on the most frequently mentioned sub-themes. The results indicate that musicians started to experience mental MPA symptoms (e.g., negative feelings) as soon as they began to prepare for public performance. To cope with mental symptoms, musicians employed mental strategies such as positive thinking/self-talk and concentration both before and during public performance. The experience of physiological MPA symptoms (e.g., increased heart rate) peaked shortly before public performance and remained throughout performance. To cope with a variety of physiological symptoms, musicians employed physical strategies, especially deep breathing and exercise, shortly before public performance. In contrast, behavioral MPA symptoms (e.g., tremor) were experienced mostly during public performance. Some musicians also reported experiencing the actual impairment of performance quality. To avoid this, musicians employed a variety of practicing techniques (e.g., playing at a slower tempo) during the preparation for public performance and performing techniques (e.g., paying attention to expressions) during public performance. Together, the present findings indicate that mental, physiological, and behavioral symptoms of MPA exhibit differential timelines and that musicians effectively utilize different coping strategies according to the temporal changes in MPA symptoms.
Collapse
Affiliation(s)
- Nanako Irie
- Department of Information Technology and Human Factors, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
- Graduate School of Education, Yokohama National University, Yokohama, Japan
| | - Yuki Morijiri
- Department of Information Technology and Human Factors, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
- Graduate School of Education, Tokyo Gakugei University, Tokyo, Japan
| | - Michiko Yoshie
- Department of Information Technology and Human Factors, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| |
Collapse
|
5
|
Smith M, Patel J, Gay S, Davison I, Buckley S. Clinical scientists' early career choices and progression: an exploratory mixed methods study. BMC Health Serv Res 2021; 21:1059. [PMID: 34615536 PMCID: PMC8494160 DOI: 10.1186/s12913-021-07064-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
Background Understanding the influences on healthcare professionals’ career choices and progression can inform interventions to improve workforce retention. Retention of health professionals is a high priority worldwide, in order to maintain expertise and meet the needs of national populations. In the UK, investment in clinical scientists’ pre-registration education is high and the need to retain motivated scientists recognised. Methods We conducted a mixed methods study to investigate the career choices and progression of early career clinical scientists. First job sector and salary of trainees who completed the UK pre-registration Scientist Training Programme (STP) between 2014 and 2019 were analysed using descriptive statistics and Chi-Squared tests. Semi-structured interviews conducted with volunteer practising clinical scientists who completed the programme in 2015 or 2016 were analysed thematically and reviewed for alignment with theories for understanding career choice and workforce retention. Results Most scientists who completed the STP between 2014 and 2019 obtained a post in the UK National Health Service (NHS) and achieved the expected starting salary. Life scientists were more likely to work in non-NHS healthcare settings than other scientific divisions; and physiological scientists less likely to achieve the expected starting salary. Experiences during training influenced career choice and progression 0–3 years post qualification, as did level of integration of training places with workforce planning. Specialty norms, staff turnover, organisational uncertainty and geographical preferences influenced choices in both the short (0–3 years) and longer term (5 + years). Interviewees reported a strong commitment to public service; and some could foresee that these priorities would influence future decisions about applying for management positions. These factors aligned with the components of job embeddedness theory, particularly that of ‘fit’. Conclusions Training experiences, personal values, specialty norms and organisational factors all influence UK clinical scientists’ early career choices and progression. Job embeddedness theory provides a useful lens through which to explore career choice and progression; and suggests types of intervention that can enhance the careers of this essential group. Interventions need to take account of variations between different scientific specialties. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07064-1.
Collapse
Affiliation(s)
- Megan Smith
- Formerly Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Jaimini Patel
- Formerly Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Sandie Gay
- Formerly National School of Healthcare Science, Health Education England, Birmingham, UK
| | - Ian Davison
- Formerly School of Education, University of Birmingham, Birmingham, UK
| | - Sharon Buckley
- Formerly Birmingham Medical School, University of Birmingham, Birmingham, UK. .,Birmingham Medical School, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT, Birmingham, United Kingdom.
| |
Collapse
|
6
|
Church HR, Agius SJ. The F3 phenomenon: Early-career training breaks in medical training. A scoping review. MEDICAL EDUCATION 2021; 55:1033-1046. [PMID: 33945168 DOI: 10.1111/medu.14543] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Since 2017, more than 50% of UK doctors have undertaken a 'Foundation 3 (F3) Year' training break after completing their foundation programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field. METHODS Following Arksey and O'Malley's guidelines, 12 databases and three UK-based national postgraduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the 'F3' time-period, including 'post-foundation' or 'pre-specialty' training. Title, abstract and full-paper screening selected articles reporting any aspect of F3, including within a wider context (eg postgraduate training breaks), and then underwent mixed-methods analysis. RESULTS Of 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, and the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK postgraduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non-clinically) and/or travel. The decision to undertake an F3 is made either prior to or during foundation training. Evidence regarding the impact of F3 on health care service provision was limited but evenly balanced. CONCLUSIONS In summarising the existing F3 evidence, this review has highlighted important issues including health care workforce equality and diversity, training pathway inflexibility and the effect of negative early-career experiences on subsequent career decisions. More research is needed to understand the financial impact of training breaks on health care service provision, how training programmes must adapt to retain more trainees and the long-term effects of training breaks, such as F3, on subsequent career progression.
Collapse
Affiliation(s)
- Helen R Church
- Faculty of Medicine and Health Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Steven J Agius
- Faculty of Medicine and Health Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| |
Collapse
|
7
|
Kassam A, Nickell L, Pethrick H, Mountjoy M, Topps M, Lorenzetti DL. Facilitating Learner-Centered Transition to Residency: A Scoping Review of Programs Aimed at Intrinsic Competencies. TEACHING AND LEARNING IN MEDICINE 2021; 33:10-20. [PMID: 32945704 DOI: 10.1080/10401334.2020.1789466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: There is currently a move to provide residency programs with accurate competency-based assessments of their candidates, yet there is a gap in knowledge regarding the role and effectiveness of interventions in easing the transition to residency. The impact of key stakeholder engagement, learner-centeredness, intrinsic competencies, and assessment on the efficacy of this process has not been examined. The objective of this scoping review was to explore the nature of the existing scholarship on programs that aim to facilitate the transition from medical school to residency. Approach: We searched MEDLINE and EMBASE from inception to April 2020. Programs were included if they were aimed at medical students completing undergraduate medical training or first year residents and an evaluative component. Two authors independently screened all abstracts and full text articles in duplicate. Data were extracted and categorized by type of program, study design, learner-centeredness, key stakeholder engagement, the extent of information sharing about the learner to facilitate the transition to residency, and specific program elements including participants, and program outcomes. We also extracted data on intrinsic (non-Medical Expert) competencies, as defined by the CanMEDS competency framework. Findings: Of the 1,006 studies identified, 55 met the criteria for inclusion in this review. The majority of the articles that were eligible for inclusion were from the United States (n = 31, 57%). Most of the studies (n = 47, 85%) employed quantitative, or mixed method research designs. Positive outcomes that were commonly reported included increased self-confidence, competence in being prepared for residency, and satisfaction with the transition program. While a variety of learner-centered programs that focus on specific intrinsic competencies have been implemented, many (n = 29, 52%) did not report engaging learners as key stakeholders in program development. Insights: While programs that aim to ease the transition from medical school to residency can enhance both Medical Expert and other intrinsic competencies, there is much room for novel transition programs to define their goals more broadly and to incorporate multiple areas of professional development. The existing literature highlights various gaps in approaches to easing the transition from medical school to residency, particularly with respect to key stakeholder engagement, addressing intrinsic CanMEDS competencies, and focusing on individual learners' needs.
Collapse
Affiliation(s)
- Aliya Kassam
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leslie Nickell
- Department of Community & Family Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Pethrick
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Department of Family Medicine, David Bradley Health Sciences Centre, Hamilton, Ontario, Canada
| | - Maureen Topps
- Medical Council of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
8
|
Sharma PR, Alsaffarini KWB. Preparation for practice and the arguments for standardisation in view of the forthcoming medical licensing exam: A literature review. MEDICAL TEACHER 2020; 42:451-456. [PMID: 31928279 DOI: 10.1080/0142159x.2019.1708291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims: The aim of this paper is to address whether the introduction of a national licensing exam will improve preparedness for practice. This review will explore and identify the areas in which UK medical graduates are feeling underprepared. In addition, this review will discuss the need for the Medical Licensing Assessment in the UK.Methods: A literature search of several databases was performed in December 2018. Studies which identified the areas in which medical graduates were prepared/unprepared for, and those which explored whether UK medical schools were adequately preparing their graduates for practice, were included. Studies exploring the preparedness of international medical graduates were excluded.Results: Sixteen articles met the final inclusion criteria and are included in this review. All the final studies are cross-sectional and are varied in their use of methods used, with the vast majority using questionnaires to identify the preparedness of medical students and junior doctors.Conclusions: This review conveys that junior doctors are mostly underprepared in emergency work. This can be associated to a lack of exposure to emergency situations during their undergraduate training. Moreover, this review suggests that the preparedness of medical graduates may remain unaffected by the implementation of the MLA.
Collapse
Affiliation(s)
- Parivrudh R Sharma
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kareem W B Alsaffarini
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
9
|
Rizan C, Montgomery J, Ramage C, Welch J, Dewhurst G. Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study. J R Soc Med 2019; 112:192-199. [PMID: 30963774 DOI: 10.1177/0141076819831872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an 'F3' year. There is a paucity of qualitative research exploring why increasingly doctors are taking F3s. The aim of this study is to explore the reasons why F2 doctors are choosing to take a year out of training and the impact upon future career choices. DESIGN This is an exploratory qualitative study, using in-depth interviews and content analysis. SETTING UK. PARTICIPANTS Fourteen participants were interviewed from one foundation school. Participants included five doctors who commenced their F3 in 2015, five who started in 2016 and finally four recently starting this in 2017. MAIN OUTCOME MEASURES Content analysis was conducted to distill the themes which exemplified the totality of the experience of the three groups. RESULTS There were four predominant themes arising within the data set which can be framed as 'unmet needs' arising within foundation years, sought to be fulfilled by the F3 year. First, doctors describe exhaustion and stress resulting in a need for a 'break'. Second, doctors required more time to make decisions surrounding specialty applications and prepare competitive portfolios. Third, participants felt a loss of control which was (partially) regained during their F3s. The final theme was the impact of taking time out upon return to training (for those participants who had completed their F3 year). When doctors returned to NHS posts they brought valuable experience. CONCLUSIONS This study provides evidence to support the important ongoing initiatives from Health Education England and other postgraduate bodies, exploring approaches to further engage, retain and support the junior doctor workforce.
Collapse
Affiliation(s)
- Chantelle Rizan
- 1 Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE, UK
| | | | - Charlotte Ramage
- 3 School of Health Sciences, University of Brighton, Brighton BN1 9QW, UK
| | - Jan Welch
- 4 South Thames Foundation School, London SE1 9RT, UK
| | - Graeme Dewhurst
- 5 Health Education England Kent Surrey and Sussex, London WC1B 5DN, UK
| |
Collapse
|
10
|
Pougnet R, Pougnet L, Dewitte JD, Jousset D, Loddé B. Vécu au travail des internes de médecine : étude qualitative. ARCH MAL PROF ENVIRO 2019. [DOI: 10.1016/j.admp.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Parry D, Oeppen R, Amin M, Brennan P. Could exercise improve mental health and cognitive skills for surgeons and other healthcare professionals? Br J Oral Maxillofac Surg 2018; 56:367-370. [DOI: 10.1016/j.bjoms.2018.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/05/2018] [Indexed: 01/01/2023]
|
12
|
Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06100] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInterventions to improve the antimicrobial prescribing practices of doctors have been implemented widely to curtail the emergence and spread of antimicrobial resistance, but have been met with varying levels of success.ObjectivesThis study aimed to generate an in-depth understanding of how antimicrobial prescribing interventions ‘work’ (or do not work) for doctors in training by taking into account the wider context in which prescribing decisions are enacted.DesignThe review followed a realist approach to evidence synthesis, which uses an interpretive, theory-driven analysis of qualitative, quantitative and mixed-methods data from relevant studies.SettingPrimary and secondary care.ParticipantsNot applicable.InterventionsStudies related to antimicrobial prescribing for doctors in training.Main outcome measuresNot applicable.Data sourcesEMBASE (via Ovid), MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Web of Science core collection limited to Science Citation Index Expanded (SCIE) and Conference Proceedings Citation Index – Science (CPCI-S) (via Thomson Reuters), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, the Health Technology Assessment (HTA) database (all via The Cochrane Library), Applied Social Sciences Index and Abstracts (ASSIA) (via ProQuest), Google Scholar (Google Inc., Mountain View, CA, USA) and expert recommendations.Review methodsClearly bounded searches of electronic databases were supplemented by citation tracking and grey literature. Following quality standards for realist reviews, the retrieved articles were systematically screened and iteratively analysed to develop theoretically driven explanations. A programme theory was produced with input from a stakeholder group consisting of practitioners and patient representatives.ResultsA total of 131 articles were included. The overarching programme theory developed from the analysis of these articles explains how and why doctors in training decide to passively comply with or actively follow (1) seniors’ prescribing habits, (2) the way seniors take into account prescribing aids and seek the views of other health professionals and (3) the way seniors negotiate patient expectations. The programme theory also explains what drives willingness or reluctance to ask questions about antimicrobial prescribing or to challenge the decisions made by seniors. The review outlines how these outcomes result from complex inter-relationships between the contexts of practice doctors in training are embedded in (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels and application in practice) and the mechanisms triggered in these contexts (fear of criticism and individual responsibility, reputation management, position in the clinical team and appearing competent). Drawing on these findings, we set out explicit recommendations for optimal tailoring, design and implementation of antimicrobial prescribing interventions targeted at doctors in training.LimitationsMost articles included in the review discussed hospital-based, rather than primary, care. In cases when few data were available to fully capture all the nuances between context, mechanisms and outcomes, we have been explicit about the strength of our arguments.ConclusionsThis review contributes to our understanding of how antimicrobial prescribing interventions for doctors in training can be better embedded in the hierarchical and interprofessional dynamics of different health-care settings.Future workMore work is required to understand how interprofessional support for doctors in training can contribute to appropriate prescribing in the context of hierarchical dynamics.Study registrationThis study is registered as PROSPERO CRD42015017802.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Mark Pearson
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Simon Briscoe
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
13
|
Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G. Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. J Antimicrob Chemother 2017; 72:2418-2430. [PMID: 28859445 PMCID: PMC5890780 DOI: 10.1093/jac/dkx194] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Background Antimicrobial resistance has led to widespread implementation of interventions for appropriate prescribing. However, such interventions are often adopted without an adequate understanding of the challenges facing doctors-in-training as key prescribers. Methods The review followed a realist, theory-driven approach to synthesizing qualitative, quantitative and mixed-methods literature. Consistent with realist review quality standards, articles retrieved from electronic databases were systematically screened and analysed to elicit explanations of antimicrobial prescribing behaviours. These explanations were consolidated into a programme theory drawing on social science and learning theory, and shaped though input from patients and practitioners. Results By synthesizing data from 131 articles, the review highlights the complex social and professional dynamics underlying antimicrobial prescribing decisions of doctors-in-training. The analysis shows how doctors-in-training often operate within challenging contexts (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels, uncertainty about application of knowledge in practice) where they prioritize particular responses (fear of criticism and individual responsibility, managing one's reputation and position in the team, appearing competent). These complex dynamics explain how and why doctors-in-training decide to: (i) follow senior clinicians' prescribing habits; (ii) take (or not) into account prescribing aids, advice from other health professionals or patient expectations; and (iii) ask questions or challenge decisions. This increased understanding allows for targeted tailoring, design and implementation of antimicrobial prescribing interventions. Conclusions This review contributes to a better understanding of how antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of different healthcare settings.
Collapse
Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Mark Pearson
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Peninsula Schools of Medicine & Dentistry, Plymouth University, Drake Circus Plymouth, Devon PL4 8AA, UK
| | - Simon Briscoe
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| |
Collapse
|
14
|
Pujara S, Solanki S. Foundation year one training in neurosurgery: achieving competency a 5-year review. Br J Neurosurg 2017; 31:718-723. [PMID: 28597704 DOI: 10.1080/02688697.2017.1339225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION F1 doctors are a rare breed in Neurosurgery, featuring in only 4 out of 40 UK centres. It is widely perceived that Neurosurgery would only provide a highly specialised experience for F1s, limiting the opportunity to achieve the core practical and clinical competencies as highlighted by the United Kingdom Foundation Programme (UKFPO). Additionally, Health Education England have increased the number of community placements such as General Practice and Psychiatry further limiting F1 placements offered in specialities like Neurosurgery. AIMS We sought to acquire the views, experiences and true perspectives of training from F1 doctors in our neurosurgery centre. Importantly, we wanted to determine whether Neurosurgery provides sufficient opportunities to achieve mandatory core foundation competencies. METHODS We invited all F1s (27) to complete a secure-web based online questionnaire comprising nine domains of training. Responses: We had an overall response rate of 96%. Ninety-six per cent of our F1s valued this placement, gaining skills that could be transferred to other specialities. Eighty-eight per cent found the post to be of similar or greater value in comparison to their other F1 posts and 66% would recommend this post to others. Ninety-two per cent of F1s felt they were adequately supervised and regular informal feedback was offered in order to ensure acquisition of core competences. Fourty-four per cent of F1s were involved in post-graduate academia. All trainees attended their mandatory F1 teaching although attendance to additional departmental teaching was limited. DISCUSSION Trainees found that Neurosurgery provided a generalised exposure not a specialised one. Ninety-two per cent felt Neurosurgery had provided sufficient educational opportunities to achieve their required competencies. Importantly, all trainees managed to achieve their core generic competencies. F1 placements in Neurosurgery are highly beneficial to both trainee and service. The placement provides more than sufficient educational opportunities to help meet mandatory training requirements. F1 doctors also augment the number of junior doctors supporting the neurosurgical service.
Collapse
Affiliation(s)
- Shyam Pujara
- a Department of Neurosurgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Sandeep Solanki
- b Department of Neurosurgery , Queen's Medical Centre , Nottingham , UK
| |
Collapse
|
15
|
Al Sinawi H, Al Alawi M, Al Qubtan A, Al Lawati J, Al Habsi A, Jose S. Perception of Preparedness for Clinical Work Among New Residents: A Cross-sectional Study from Oman. Oman Med J 2017; 32:201-206. [PMID: 28584600 DOI: 10.5001/omj.2017.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate new residents' perceptions of their own preparedness for clinical practice and examine the associated factors. METHODS This is a cross-sectional study conducted on August 20-23, 2016. New residents accepted for postgraduate training by Oman Medical Specialty Board were asked to complete the Preparation for Hospital Practice Questionnaire (PHPQ). Data was analyzed using the Statistical Package for the Social Sciences version 22. RESULTS A total of 160 residents were invited to participate in this study. Out of 160, 140 residents participated (87.5%), 70.7% were female and 59.3% were graduates from Sultan Qaboos University (SQU). Ninety-nine percent of the graduates were either 'well prepared' or 'fairly well prepared' for hospital practice. Male residents scored higher in the confidence scale, while residents who did a post-internship general practice placement scored higher in understanding science. Graduates from Oman Medical College felt more prepared compared to graduates from SQU. CONCLUSIONS Most of the new residents were well prepared to clinical work. Factors such as place of undergraduate study, training, and duration of internship significantly influenced the residents' perception of preparedness. Addressing these factors will enhance residents' preparedness for clinical work.
Collapse
Affiliation(s)
- Hamed Al Sinawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Al Alawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al Qubtan
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Jaber Al Lawati
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Assad Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sachin Jose
- Department of Research, Oman Medical Specialty Board, Muscat, Oman
| |
Collapse
|
16
|
Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. Br J Gen Pract 2017; 67:e248-e252. [PMID: 28246097 DOI: 10.3399/bjgp17x689881] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND It has been suggested that the quantity of exposure to general practice teaching at medical school is associated with future choice of a career as a GP. AIM To examine the relationship between general practice exposure at medical school and the percentage of each school's graduates appointed to a general practice training programme after foundation training (postgraduate years 1 and 2). DESIGN AND SETTING A quantitative study of 29 UK medical schools. METHOD The UK Foundation Programme Office (UKFPO) destination surveys of 2014 and 2015 were used to determine the percentage of graduates of each UK medical school who were appointed to a GP training programme after foundation year 2. The Spearman rank correlation was used to examine the correlation between these data and the number of sessions spent in placements in general practice at each medical school. RESULTS A statistically significant association was demonstrated between the quantity of authentic general practice teaching at each medical school and the percentage of its graduates who entered GP training after foundation programme year 2 in both 2014 (correlation coefficient [r] 0.41, P = 0.027) and 2015 (r 0.3, P = 0.044). Authentic general practice teaching here is described as teaching in a practice with patient contact, in contrast to non-clinical sessions such as group tutorials in the medical school. DISCUSSION The authors have demonstrated, for the first time in the UK, an association between the quantity of clinical GP teaching at medical school and entry to general practice training. This study suggests that an increased use of, and investment in, undergraduate general practice placements would help to ensure that the UK meets its target of 50% of medical graduates entering general practice.
Collapse
|
17
|
Lewis TL, Sagmeister ML, Miller GW, Boissaud-Cooke MA, Abrahams PH. Anatomy, radiology, and practical procedure education for foundation doctors in England: A National Observational Study. Clin Anat 2016; 29:982-990. [DOI: 10.1002/ca.22783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Thomas L. Lewis
- St George's Hospital; Blackshaw Road London SW17 0QT United Kingdom
| | | | - George W. Miller
- King's College London School of Medicine; Strand London WC2R 2LS United Kingdom
| | | | - Peter H. Abrahams
- Warwick Medical School, University of Warwick; Gibbet Hill Road Coventry CV4 7AL United Kingdom
| |
Collapse
|
18
|
Lambert T, Smith F, Goldacre MJ. Doctors' views about their work, education and training three years after graduation in the UK: questionnaire survey. JRSM Open 2015; 6:2054270415616309. [PMID: 26664735 PMCID: PMC4668918 DOI: 10.1177/2054270415616309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives Doctors who graduated in the UK after 2005 have followed a restructured postgraduate training programme (Modernising Medical Careers) and have experienced the introduction of the European Working Time Regulation and e-portfolios. In this paper, we report the views of doctors who graduated in 2008 three years after graduation and compare these views with those expressed in year 1. Design Questionnaires about career intentions, destinations and views sent in 2011 to all medical graduates of 2008. Participants 3228 UK medical graduates. Main outcome measures Comments on work, education and training. Results Response was 49% (3228/6538); 885 doctors wrote comments. Of these, 21.8% were unhappy with the standard of their training; 8.4% were positive. Doctors made positive comments about levels of supervision, support, morale and job satisfaction. Many doctors commented on poor arrangements for rotas, cover and leave, which had an adverse effect on work-life balance, relationships, morale and health. Some doctors felt pressured into choosing their future specialty too early, with inadequate career advice. Themes raised in year 3 that were seldom raised in year 1 included arrangements for flexible working and maternity leave, obtaining posts in desired locations and having to pay for courses, exams and conferences. Conclusions Many doctors felt training was available, but that European Working Time Regulation, rotas and cover arrangements made it difficult to attend. Three years after graduation, doctors raised similar concerns to those they had raised two years earlier, but the pressures of career decision making, family life and job seeking were new issues.
Collapse
|
19
|
Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:178. [PMID: 26489421 PMCID: PMC4618348 DOI: 10.1186/s12909-015-0463-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/12/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. METHODS Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. RESULTS Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. CONCLUSION Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.
Collapse
Affiliation(s)
| | - Tashmin Khamis
- The Aga Khan University, P.O. Box 30270, GPO 00100, Nairobi, Kenya.
| | - Mushtaq Ahmed
- The Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania.
| | | |
Collapse
|
20
|
Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:178. [PMID: 26489421 DOI: 10.5539/hes.v3n1p115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/12/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. METHODS Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. RESULTS Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. CONCLUSION Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.
Collapse
Affiliation(s)
| | - Tashmin Khamis
- The Aga Khan University, P.O. Box 30270, GPO 00100, Nairobi, Kenya.
| | - Mushtaq Ahmed
- The Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania.
| | | |
Collapse
|
21
|
Sheehan S, Robbins A, Porter T, Manley J. Why does moral reasoning not improve in medical students? INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2015; 6:101-2. [PMID: 26312437 PMCID: PMC4560952 DOI: 10.5116/ijme.55d4.c8e4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/19/2015] [Indexed: 05/17/2023]
Affiliation(s)
- Sebastian Sheehan
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Andrew Robbins
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Thomas Porter
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John Manley
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| |
Collapse
|