How do UK medical graduates rate their knowledge and skills in sexual health and HIV medicine? A national survey

How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014

OBJECTIVE

To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions.

DESIGN

A rapid review of the literature (registration #CRD42013005305).

DATA SOURCES

Nine major databases (and key websites) were searched in two timeframes (July-September 2013; updated May-June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures.

DATA EXTRACTION

At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013-2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes.

RESULTS

Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy.

CONCLUSIONS

Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors.

The role of people living with HIV as patient instructors - reducing stigma and improving interest around HIV care among medical students

People living with HIV/AIDS (PHAs) are increasingly recognized as experts in HIV and their own health. We developed a simulated clinical encounter (SCE) in which medical students provided HIV pre- and post-test counselling and point-of-care HIV testing for PHAs as patient instructors (PHA-PIs) under clinical preceptor supervision. The study assessed the acceptability of this teaching tool with a focus on assessing impact on HIV-related stigma among medical students. University of Toronto pre-clerkship medical students participated in a series of SCEs facilitated by 16 PHA-PIs and 22 clinical preceptors. Pre- and post-SCE students completed the validated Health Care Provider HIV/AIDS Stigma Scale (HPASS). HPASS measures overall stigma, as well as three domains within HIV stigma: stereotyping, discrimination, and prejudice. Higher scores represented higher levels of stigma. An additional questionnaire measured comfort in providing HIV-related care. Mean scores and results of paired t-tests are presented. Post-SCE, students (n   =   62) demonstrated decreased overall stigma (68.74 vs. 61.81, p   <   .001) as well as decreased stigma within each domain. Post-SCE, students (n   =   67) reported increased comfort in providing HIV-related care (10.24 vs. 18.06, p   <   .001). Involving PHA-PIs reduced HIV-related stigma among medical students and increased comfort in providing HIV-related care.

What do GUM physicians think should be taught in a modern undergraduate GUM module? A qualitative inquiry

Traditional undergraduate Genitourinary Medicine (GUM) teaching in the UK concentrated on the management of individual sexually transmitted infections. There is significant variation, however, in the GUM teaching provided by different medical schools today. I undertook a qualitative interview study to gather views of GUM and other sexual health clinicians regarding what should be taught within a modern undergraduate GUM module. Nine GUM clinicians and two Sexual and Reproductive Health (SRH) clinicians participated in the study; all were directly involved in undergraduate teaching. Semi-structured interviews were conducted with study participants by a single interviewer, focusing on three key topics: their individual opinions regarding important learning outcomes (LOs) for a modern model GUM curriculum, their preferred teaching methods and the total recommended teaching time required. Interviews were audio-recorded with consent and professionally transcribed. Data were analysed by the content analysis method. Interviewees frequently stressed skill and attitudinal LOs, even above knowledge. Recommended important skills included sexual history taking, HIV risk assessment and testing, and male and female genital examination. Recommended attitudinal LOs were developing an open and non-judgemental approach to sexual health issues and understanding sexual well-being to be an important component of general health. Respondents were keen for a mixture of teaching methods, but generally agreed that clinic attendance and experiential learning were beneficial. They preferred that GUM teaching should be delivered in the latter years of the undergraduate curriculum.

Development, implementation, and evaluation of a student-initiated undergraduate medical education elective in HIV care

BACKGROUND

The literature indicates that medical students require more comprehensive HIV training.

AIM

Medical students at the University of Toronto developed and implemented the preclerkship HIV elective (PHE) with the aim to increase trainee HIV knowledge, address important issues in HIV care, and prepare students to serve affected populations.

METHODS

Developed in partnership with the Ontario HIV Treatment Network and in consultation with local AIDS service organizations and the University of Toronto Faculty of Medicine, the PHE was inaugurated in November 2008 as an elective supplement to medical curriculum content. Eighteen second-year medical students participated in the PHE, consisting of lectures, small group sessions, clinical observerships, community placements, reading assignments, and an HIV counseling and testing workshop. Participants completed a self-assessment of HIV knowledge prior to starting and after PHE completion.

RESULTS

Self-assessment scores of HIV knowledge among PHE participants significantly increased from 78.1% (pre-PHE) to 90.2% (post-PHE) (p = 0.0016). Common themes from feedback on participant satisfaction included enthusiasm for small group sessions, clinical observerships, community agency placements, and the diversity of topics covered.

CONCLUSIONS

Student-run initiatives can supplement medical curriculum content and program feedback may be used to advocate for curriculum changes. Factors influencing success include student leadership and interest, community partnerships, and faculty mentorship.

An audit highlighting a lack of awareness of the UK national guidelines for HIV testing, 2008

Following the publication of the UK national guidelines for HIV testing 2008, we carried out a local audit to determine the level of awareness of these guidelines among doctors working in Sunderland Royal Hospital, Sunderland, UK. An email questionnaire was distributed. Over two-thirds of respondents were unaware of the publication of the guidelines. Only 36% of respondents felt comfortable in offering a patient testing for HIV. The majority of doctors who responded lacked knowledge and confidence in issues surrounding HIV management and diagnosis, suggesting that better dissemination of information and training is still needed.

How prepared are our future doctors for HIV/AIDS?

Three cohorts (n = 391) of final-year medical students in Hong Kong were evaluated on their preparedness to provide HIV care. Through a self-administered questionnaire, half (53%) were assessed to be better prepared and had a lower perceived risk of infection at work, though unwillingness to manage HIV patients was reported in a minority (4.6%). For a majority of medical students (72.8%), a specially-designed clinic attachment offered the only opportunity to come face-to-face with HIV patients for the first time. With continued improvement in treatment effectiveness, HIV/AIDS is evolving to become a new chronic disease in most societies. Curriculum development in HIV medicine remains a challenge in this HAART era.

Evaluation of sexual health medicine teaching at medical schools in Australia and New Zealand

Background: In the absence of guidelines for sexual health medicine (SHM) curriculum for medical schools in Australia and New Zealand, little is known about the current curriculum. We therefore, sought to quantitatively and qualitatively measure the existing SHM teaching at medical schools in the region. Methods: SHM specialists and Deans (or their nominated delegates) were requested to complete a questionnaire with respect to the SHM teaching in their associated medical schools. Results: Forty-two specialists completed the questionnaire. Wide variations were found in the time spent on various topics in SHM. ‘Training to teach’ was found to be a major unmet need of SHM specialists. Four (16.7%) of 24 medical schools completed the questionnaire. The total time allocated to SHM in these medical schools varied from 13.6 to 39.0 h, with a median of 31.1 h. At least 70% of key SHM topics were covered in all curricula. Conclusion: SHM teaching varied markedly in terms of subject matter, allocated time and teaching modalities. National guidelines for the teaching of SHM to medical students could facilitate the development of more consistent standards within the medical workforce. Training in teaching and learning methods to specialists may improve dissemination of sexual health skills to the wider medical workforce.