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Jandhyala R, Rout R. Observing expert opinion of medical affairs pharmaceutical physicians on the value of their clinical experience to the pharmaceutical industry using the Jandhyala method. Curr Med Res Opin 2023; 39:1541-1550. [PMID: 36632732 DOI: 10.1080/03007995.2023.2165814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The pharmaceutical industry requires a highly qualified workforce with diverse skillsets. Medical affairs pharmaceutical physicians (MAPPs) have unique qualifications among pharmaceutical company employees, but the exact contribution of their education and training is unknown. This study aimed to identify the medical education and training competencies MAPPs use in the pharmaceutical industry in relation to the four external stakeholders, regulators, payors, prescribers, and patients. METHOD Ten MAPPs were recruited using convenience sampling via professional networks. A systematic literature review and the Jandhyala method, a two-stage qualitative online consensus method, identified which of MAPPs' medical education and training competencies they used in their work with each external stakeholder. Statistical analyses determined heterogeneity in the relevance of competencies and competency categories to each stakeholder. RESULTS Nine MAPPs completed the study. Of the 59 competencies identified, 54 were relevant to all external stakeholders. Relevance of competencies varied significantly between external stakeholders (p = .0434). Binary competency scores varied significantly for three pairs of stakeholders, "patient vs. payor" (p = .025), "prescriber vs. regulator" (p = .013) and "prescriber vs. payor" (p = .008). Between-stakeholder overall frequency count varied significantly for two of the nine competency categories. CONCLUSION MAPPs develop a highly specialized set of competencies during medical education and training from which they use distinct subsets to meet the needs of external stakeholders in the pharmaceutical industry. Undergraduate and postgraduate competency-based medical education appears to prepare MAPPs for cognitive and technical work. Further exploration may aid understanding of how they develop soft skills.
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Affiliation(s)
- Ravi Jandhyala
- Medialis Ltd., England, UK
- Centre for Pharmaceutical Medicine Research, King's College London, University of London, London, UK
| | - Raj Rout
- Vertex Pharmaceuticals, London, UK
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2
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Birkeli CN, Normand C, Rø KI, Kvernenes M. Educational supervision in internal medicine residency training - a scoping review. BMC MEDICAL EDUCATION 2023; 23:644. [PMID: 37679738 PMCID: PMC10486128 DOI: 10.1186/s12909-023-04629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Although supervision is an important part of residency training, its scope and how it relates to other types of support, such as mentoring, precepting and feedback, remain unclear. While clinical supervision consists of ongoing instructions and feedback in the workplace setting, educational supervision is a formalized component of postgraduate medical educational and supports the process that facilitates a trainee's progression throughout their training. Since medical specialties have different supervisory traditions, this study focuses on educational supervision in internal medicine. Our aim was to investigate what is known about educational supervision practices in internal medicine and the role of educational supervision in supporting residents' learning. METHODS We conducted a scoping review of the literature on educational supervision in residency training in internal medicine based on Levac et al.'s modification of Arksey and O'Malley's six-step framework. The literature search was performed in the following databases: Medline, Embase, Web of Science and the Educational Resources Information Center. In addition, we conducted a handsearch in Medical Teacher and Google Scholar. We followed the PRISMA guidelines for systematic research. RESULTS Eighteen of the 3,284 identified articles were included in the analysis. We found few empirical studies describing how educational supervision is conducted and what effect routine educational supervision has on residents' learning. Our findings suggest that the terminology can be confusing and that educational supervision practices in internal medicine has a weak theoretical foundation. CONCLUSION The distinction between educational supervision and other support structures, such as mentoring and feedback, has not been clearly defined in the research literature. We argue that shared terminology is needed to better understand current educational practices and to facilitate clear communication about how to help residents learn.
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Affiliation(s)
- Cecilie Normann Birkeli
- Institute for Studies of the Medical Profession, P.O. Box 1153, Oslo, NO-0107, Norway.
- Center for Medical Education, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Camilla Normand
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
- Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karin Isaksson Rø
- Institute for Studies of the Medical Profession, P.O. Box 1153, Oslo, NO-0107, Norway
| | - Monika Kvernenes
- Center for Medical Education, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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3
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Said UN, Al-Hashimi K, Khan TN, Ismail OM, El-Omar O. Exploring the Roles and Responsibilities of an Educational Supervisor in Medical Training Within the United Kingdom. Cureus 2023; 15:e41244. [PMID: 37529816 PMCID: PMC10388216 DOI: 10.7759/cureus.41244] [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: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Medical trainees or junior doctors within the United Kingdom, regardless of their level of training or specialty, are assigned an educational supervisor (ES). The General Medical Council within the United Kingdom defines an ES as "a trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified trainee's educational progress during a clinical placement or series of placements." This article critically evaluates the current literature to explore the roles of the ES in supporting and monitoring a trainee's progress while discussing challenges associated with the role. Through clearer delineation of the role of an ES, barriers to improving training can be identified and overcome, thus improving overall satisfaction with training.
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Affiliation(s)
- Umar N Said
- Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire, Coventry, GBR
| | | | - Taherah N Khan
- General Medicine, Worcestershire Acute Hospitals NHS Trust, Worcestershire, GBR
| | - Omar M Ismail
- Trauma & Orthopaedics, Royal Lancaster Infirmary, Lancaster, GBR
| | - Omar El-Omar
- Trauma and Orthopaedics, King's Mill Hospital, Nottinghamshire, GBR
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Kerins J, McCully E, Stirling SA, Smith SE, Tiernan J, Tallentire VR. The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland. BMC MEDICAL EDUCATION 2022; 22:621. [PMID: 35974371 PMCID: PMC9380968 DOI: 10.1186/s12909-022-03654-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intercostal chest drain (ICD) insertion is a skill that medical trainees lack confidence in performing. This study explores the impact of a national programme of Simulation-Based Mastery Learning (SBML) on procedural confidence, including the impact of time intervals between booster sessions and interim clinical experience. METHODS Internal Medicine Trainees in Scotland were surveyed about confidence and clinical experience with ICD insertion before and immediately after SBML and booster session. Data were matched and analysed using paired sample t-tests. Short interval and long interval groups were compared using Student's unpaired t-test. The impact of interim clinical experience was assessed using Analysis of Variance. RESULTS Mean confidence in ICD insertion rose following SBML, fell between initial and booster session, and increased again following booster session (P = < 0.001). 33 of 74 trainees had successfully inserted an ICD between sessions. Fall in confidence was unaffected by the time interval between training sessions, but was mitigated by interim clinical experience. CONCLUSIONS SBML boosts trainee confidence in ICD insertion. However, there is evidence of confidence decay, possibly due to a lack of clinical experience between sessions. More research is needed to explore barriers to transfer of skills from simulated to real-world environments.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK.
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.
| | | | | | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
- NHS Lothian, Edinburgh, UK
| | - James Tiernan
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
- NHS Lothian, Edinburgh, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
- NHS Education for Scotland, Glasgow, UK
- NHS Lothian, Edinburgh, UK
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Carasco C, Wang H, Orhan O. 'Make me a med reg'; a simulation course to equip internal medical trainees with the skills to perform the medical registrar role. Future Healthc J 2022; 9:62-63. [PMID: 36310944 PMCID: PMC9601043 DOI: 10.7861/fhj.9-2-s62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Clare Carasco
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Han Wang
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Orhan Orhan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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McAleer P, Tallentire VR, Stirling SA, Edgar S, Tiernan J. Postgraduate medical procedural skills: attainment of curricular competencies using enhanced simulation-based mastery learning at a novel national boot camp. Clin Med (Lond) 2022; 22:125-130. [PMID: 35304373 PMCID: PMC8966818 DOI: 10.7861/clinmed.2021-0578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A new UK medical postgraduate curriculum prompted the creation of a novel national medical postgraduate 'boot camp'. An enhanced simulation-based mastery learning (SBML) methodology was created to deliver procedural skills teaching within this national boot camp. This study aimed to explore the impact of SBML in a UK medical boot camp. METHODS One-hundred and two Scottish medical trainees attended a 3-day boot camp starting in August 2019. The novel enhanced SBML pathway entailed online pre-learning resources, deliberate practice, and simulation assessment and feedback. Data were gathered via pre- and post-boot camp questionnaires and assessment checklists. RESULTS The vast majority of learners achieved the required standard of performance. Learners reported increased skill confidence levels, including skills not performed at the boot camp. CONCLUSION An enhanced SBML methodology in a boot camp model enabled streamlined, standardised procedural skill teaching to a national cohort of junior doctors. Training curricular competencies were achieved alongside increased skill confidence.
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Affiliation(s)
| | - Victoria R Tallentire
- NHS Education for Scotland, Edinburgh, UK and consultant in acute medicine, NHS Lothian, Edinburgh, UK
| | | | - Simon Edgar
- NHS Lothian, Edinburgh, UK and consultant anaesthetist, NHS Lothian, Edinburgh, UK
| | - James Tiernan
- NHS Lothian, Edinburgh, UK and a consultant in respiratory medicine, NHS Lothian, Edinburgh, UK
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Nedungadi A, Ming C, Woodward F, Lasoye T, Birns J. Supporting the transition to becoming a medical registrar. Future Healthc J 2021; 8:e160-e163. [PMID: 33791499 DOI: 10.7861/fhj.2020-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Physician training is seeing increasing numbers of doctors adopting the role of medical registrar. Non-clinical as well as clinical responsibilities are a source of great anxiety prior to trainees assuming this role. Methods A standardised, blended, 1-day course to address the needs of doctors transitioning to become a medical registrar was designed and delivered across four hospitals. A mixed methods evaluation approach was employed to assess the effect of the course. Results Thirty-four trainees approaching the transition to becoming a medical registrar participated. Quantitative and qualitative analysis of participants' written feedback showed a significant pre- to post-course increase in candidates' self-reported confidence in undertaking the medical registrar role along with learning in non-technical skills. Discussion This course was shown to be effective in helping to improve the confidence of trainees approaching the medical registrar role. The carefully designed standardised format may facilitate wider expansion of such training.
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Affiliation(s)
| | | | | | - Tunji Lasoye
- consultant and honorary senior lecturer in emergency medicine, King's College Hospital, London, UK
| | - Jonathan Birns
- geriatrics and general medicine, Guy's and St Thomas' NHS Foundation Trust, and deputy head, London School of Medicine for Health Education England, London, UK
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Woodfield G, Tyson LD, Orhan O, Szram J. Development of a north-west London paracentesis simulation course for core medical trainees. Future Healthc J 2021; 8:e131-e136. [PMID: 33791492 PMCID: PMC8004348 DOI: 10.7861/fhj.2020-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We designed, implemented and evaluated a near-peer simulation training programme teaching diagnostic and therapeutic abdominal paracentesis to core medical trainees (CMTs). We taught diagnostic and therapeutic abdominal paracentesis to 77 north-west London CMTs over 8 training days over 4 years, 2015 to 2019. The programme was optimised by use of plan, do, study, act (PDSA) cycles and the content was evaluated by anonymous pre- and post-course questionnaires. There was a need for this training; 89% of participants reported inadequate training opportunities pre-course and only 28% felt 'confident' or 'very confident' to insert an ascitic drain. Simulation training appears effective when teaching these skills. Having been low in confidence before the course, all participants reported increased confidence after completing the course. Simulation training has been highlighted as a key aspect of the new internal medicine training programme, which replaces CMT. We would recommend using PDSA cycles to implement effective simulation programmes.
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Affiliation(s)
- Georgia Woodfield
- West Middlesex University Hospital, London, UK and clinical research fellow, Imperial College London, London, UK
| | - Luke D Tyson
- London North West University Healthcare NHS Trust, London, UK and honorary clinical research fellow, Imperial College London, London, UK
| | - Orhan Orhan
- Chelsea and Westminster Hospital, London, UK
| | - Joanna Szram
- Royal Brompton Hospital, London, UK, deputy postgraduate dean and clinical lead for physician specialty recruitment, Health Education England South London, London, UK and honorary senior lecturer, National Heart and Lung Institute, London, UK
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Bagonza A, Peterson S, Mårtensson A, Mutto M, Awor P, Kitutu F, Gibson L, Wamani H. 'I know those people will be approachable and not mistreat us': a qualitative study of inspectors and private drug sellers' views on peer supervision in rural Uganda. Global Health 2020; 16:106. [PMID: 33109214 PMCID: PMC7590471 DOI: 10.1186/s12992-020-00636-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than 5 years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda. METHODS In this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with 130 drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management. RESULTS A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. CONCLUSION Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.
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Affiliation(s)
- Arthur Bagonza
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | - Stefan Peterson
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
- Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Milton Mutto
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Freddy Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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10
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Birns J, Mullender C, Balch I, Bryant C, Deaner A. Evaluation of training programmes mapped to the new internal medicine curriculum. Future Healthc J 2020; 7:116-119. [PMID: 32550278 DOI: 10.7861/fhj.2019-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In preparation for the internal medicine training (IMT) programme introduced in 2019, the core medical training (CMT) programme in London was made 'IMT-ready' in 2018 by creating new rotations that reflected the compulsory requirements of the first 2 years of the IMT curriculum, including provision of the requisite number of critical care placements. Core medical trainees completed posts within the 'IMT-ready' programme between August 2018 and August 2019, during which time the trainee experience was evaluated. A total of 497 responses were received. Of these, 96% of trainees were on an 'acute unselected take' on-call rota, 79% were able to attend outpatient clinics, 80% had the opportunity to practise procedural skills and 88% had the opportunity to apply palliative care skills. Clear areas for improvement were identified that predominantly focused on the need to optimise trainee attendance of outpatient clinics and the number of patients seen during an acute take. With respect to future career intentions, only 63% of trainees planned on applying to a group 1 (with general medicine) higher medical specialty. Thematic analysis of trainees in critical care placements highlighted an appreciation of the level of senior support, feeling well integrated into the team, a positive experience of induction and excellent opportunities for performing procedures.
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Affiliation(s)
- Jonathan Birns
- Health Education England, London, UK and consultant in stroke medicine, geriatrics and general medicine, St Thomas' Hospital, London, UK
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11
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Pucher PH, Peckham-Cooper A, Fleming C, Mohamed W, Clements JM, Nally D, Humm G, Mohan HM. Consensus recommendations on balancing educational opportunities and service provision in surgical training: Association of Surgeons in Training Delphi qualitative study. Int J Surg 2020; 84:207-211. [PMID: 32276079 DOI: 10.1016/j.ijsu.2020.03.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 03/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ensuring the highest quality of surgical training remains a challenge as demands on health service provision rise. This study aimed to explore the differences and potential conflicts between service provision and dedicated training activity provided by surgical trainees, and recommend solutions. METHODS Participants were drawn from the Association of Surgeons in Training (ASiT) national council. Nominal Group Technique (NGT) was employed by members of the ASiT executive addressing 3 key domains (1) defining differences between training and service tasks, (2) impact of service-provision on training and (3) ways to improve training. A two-round Delphi process was conducted via electronic survey to ASiT council. Consensus was considered achieved for any statement where 80% or more of respondents indicated agreement. RESULTS 47 statements were generated through NGT which were put to the Delphi process. Consensus was reached on a total of 24/47 statements. Educational or training tasks were identified as being activities which progressed a trainee's skill set, could be tailored to a trainee's own ability, and involved acting as a trainer to more junior colleagues. The negative impact of excess service provision included training quality, trainee mental health, and surgical trainee recruitment. Potential measures to improve training included increasing hospital staffing and resources, protected training times, trainee-specific or competency-based learning and training or incentivising trainers. CONCLUSION This trainee-based study provides several consensus recommendations on the characteristics that define surgical training and how a balance between service provision and training can potentially be achieved. Policy makers and health systems may be guided by these to ensure high quality training and a satisfied workforce.
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Affiliation(s)
- Philip H Pucher
- The Association of Surgeons in Training, United Kingdom; Wessex Deanery HEE, United Kingdom.
| | - Adam Peckham-Cooper
- The Association of Surgeons in Training, United Kingdom; Yorkshire & Humber HEE, United Kingdom
| | - Christina Fleming
- The Association of Surgeons in Training, United Kingdom; Department of Colorectal Surgery, Cork University Hospital, Ireland
| | - Walid Mohamed
- The Association of Surgeons in Training, United Kingdom
| | | | - Deirdre Nally
- The Association of Surgeons in Training, United Kingdom
| | - Gemma Humm
- The Association of Surgeons in Training, United Kingdom
| | - Helen M Mohan
- The Association of Surgeons in Training, United Kingdom
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Roycroft M, Abad-Madroñero J, Cochrane C, Poots A, Novak M, Tallett A, Burger SA, FitzPatrick M. ‘This is my vocation; is it worth it?’ Why do core medical trainees break from training? Future Healthc J 2020; 7:s103-s104. [DOI: 10.7861/fhj.7.1.s103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Cucknell C, George E, Saunders M. Preparing to be the medical registrar on call: the evolution of a simulation programme. Future Healthc J 2020; 7:s90. [DOI: 10.7861/fhj.7.1.s90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Machin LL, Latcham N, Lavelle C, Williams RA, Corfield L. Exploring the perceived medical ethics and law training needs of UK foundation doctors. MEDICAL TEACHER 2020; 42:92-100. [PMID: 31558083 DOI: 10.1080/0142159x.2019.1665636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Foundation doctors (FDs) encounter a wide range of ethical and legal issues during their first two years of work. Despite ethics being a key part of most modern undergraduate curricula, FDs can struggle with the issues they see. This study is based on results from an on-line survey answered by 479 UK FDs regarding their medical law and ethics learning needs, and their undergraduate training in this area. Over two-thirds stated they would wish to receive MEL training as an FD on self-discharge against medical advice (∼71%), sedating patients (∼70%), decision making in emergency medicine (∼67%), and withholding and withdrawing treatment (∼66%). Over half of all respondents want MEL training during their Foundation Programme on DNACPR orders (∼63%), dealing with patients with suicidal intent (∼59%), Mental Health Act (∼55%), Deprivation of Liberty Safeguards (∼54%), and end of life care (∼53%). We therefore propose a minimum curriculum for ethics and law training for FDs based on these topics, as well as cases brought by the FDs themselves.
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Affiliation(s)
- L L Machin
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - N Latcham
- University Hospitals of Morecambe Bay Foundation Trust, Lancaster, UK
| | - C Lavelle
- Wirral GP Specialty Training Scheme, Birkenhead, UK
| | - R A Williams
- Lancaster University Management School, Lancaster University, Lancaster, UK
| | - L Corfield
- Keele Medical School, Keele University, Staffordshire, UK
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15
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Armstrong M, Black D, Miller A. Quality Criteria for Core Medical Training: A Resume of Their Development, Impact and Future Plans. J R Coll Physicians Edinb 2019; 49:230-236. [DOI: 10.4997/jrcpe.2019.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background In 2015 the Joint Royal Colleges of Physicians Training Board (JRCPTB), acting on behalf of the three UK Royal Colleges of Physicians, launched a set of quality criteria designed to improve the educational experience of Core Medical Trainees. Methods The criteria were developed with key stakeholders from Core Medical Training (CMT) and monitored via the General Medical Council's annual National Training Survey. This paper describes the development, implementation and impact of these criteria, which have been implemented by UK postgraduate schools of medicine since 2015. Results There were trainee-reported improvements from baseline (2015-18) in at least eight out of the 13 core criteria measured. Conclusions The results demonstrate that a coordinated UK-wide approach to quality improvement, focused on a specific set of clearly defined and measurable outcomes that galvanise trainer engagement, can lead to greater trainee satisfaction in a demanding area of medicine without significant additional resources.
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Affiliation(s)
- Miriam Armstrong
- Senior Policy Adviser, Joint Royal Colleges of Physicians Training Board, Federation of Royal Colleges of Physicians of the United Kingdom, London, UK
| | - David Black
- International Medical Director for Training and Development (previously Medical Director, Joint Royal Colleges of Physicians Training Board), Federation of the Royal Colleges of Physicians of the United Kingdom, London, UK
| | - Alastair Miller
- Deputy Medical Director, Joint Royal Colleges of Physicians Training Board, Federation of Royal Colleges of Physicians of the United Kingdom, London, UK
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16
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Goh YY, Luintel A, Nassrally S. ‘Ready to Reg’ – a pilot trial of experiential medical registrar training. Future Healthc J 2019. [DOI: 10.7861/futurehealth.6-2-s36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Mathew R, Weil A, Sleeman KE, Bristowe K, Shukla P, Schiff R, Flanders L, Leonard P, Minton O, Wakefield D, St John K, Carey I. The Second Conversation project: -Improving training in end of life care communication among junior doctors. Future Healthc J 2019; 6:129-136. [PMID: 31363520 PMCID: PMC6616182 DOI: 10.7861/futurehosp.6-2-129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Junior doctors describe a need for greater support and training in end of life care (EoLC) communication skills. The Second Conversation project was designed by a multi-professional steering group as a workplace based training intervention for junior doctors to improve their skills and confidence in undertaking EoLC conversations. Qualitative interviews were carried out with 11 junior doctors and five senior doctors across two sites who took part in, or facilitated, a 'second conversation'. This is a three-step training intervention that involves 1) observation - the junior doctor observes an EoLC conversation between a senior doctor and patient/caregiver; 2) direct experience - the junior doctor undertakes a follow-up second conversation with the patient/caregiver; and 3) reflection - the junior doctor discusses and reflects on the experience with a senior colleague. Interviews were analysed using framework analysis and findings informed iterative changes to the intervention and its implementation using 'Plan, Do, Study, Act' cycles. Benefits that were identified included the flexibility of the intervention and its positive impact on the confidence and skills of junior doctors. The Second Conversation was felt to be of most value to newly qualified doctors and worked well on wards where length of stay was longer and EoLC conversations frequently happen. Further evaluation and exploration of patient and caregiver experiences is required.
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Affiliation(s)
- Rammya Mathew
- Wembley Park Drive Medical Centre and Islington GP Federation, Wembley, UK
| | - Anna Weil
- North London Hospice and Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, UK
| | | | | | - Lucy Flanders
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Ollie Minton
- Brighton and Sussex University Hospitals NHS Trust, Brighton UK
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18
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Goh YY, Luintel A, Nassrally S. 'Ready to Reg' - a pilot trial of experiential medical registrar training. Future Healthc J 2019; 6:36. [PMID: 31572932 PMCID: PMC6752443 DOI: 10.7861/futurehosp.6-2s-s36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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19
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Roberts S, Howarth S, Millott H, Stroud L. Experience of the impact of physician associates on -postgraduate medical training: A mixed methods -exploratory study . Clin Med (Lond) 2019; 19:4-10. [PMID: 30651237 PMCID: PMC6399627 DOI: 10.7861/clinmedicine.19-1-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The introduction of new professional roles to the multidisciplinary team has been heralded as a way to facilitate medical education in the face of increasing service pressures. However, concerns have been raised that the training of new healthcare professionals will dilute the availability of learning opportunities, thereby detracting from postgraduate medical education. As part of a mixed methods exploratory study, the experienced impact of newly qualified physician associates on medical training was explored. Within 6 months of newly qualified physician associates being introduced, half of junior doctors reported no overall impact on their training and a third felt that their training was enhanced by the presence of physician associates. A minority of trainees experienced dilution of training opportunities. The findings support the notion that new healthcare professionals do not detract from medical training and suggest that roles such as the physician associate have potential to enhance postgraduate medical education.
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Affiliation(s)
- Sam Roberts
- Leeds Institute of Health Sciences, Leeds, UK
| | | | | | - Laura Stroud
- Leeds Institute of Health Sciences, Leeds, UK
- School of Medicine (Student Education), Leeds, UK
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20
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Beckwith H, Kingsbury M, Horsburgh J. Why do people choose nephrology? Identifying positive motivators to aid recruitment and retention. Clin Kidney J 2018; 11:599-604. [PMID: 30288258 PMCID: PMC6165757 DOI: 10.1093/ckj/sfy076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/15/2018] [Indexed: 11/14/2022] Open
Abstract
Increasing concerns about recruitment and retention of junior doctors have led to renewed interest in how and when trainees choose their specialties. To our knowledge, no study has yet reported what attracts UK applicants to nephrology nor how clinicians develop vocational interests or make occupational choices. With this in mind, we sought to explore the motivation behind current nephrologist's career choices in the UK. We interviewed 11 nephrologists using a semi-structured face-to-face approach and used interpretative phenomenological analysis to conduct and analyse the interviews. We found role models were pivotal in encouraging specialization in nephrology, particularly those encountered in early postgraduate training. The diversity, diagnostic challenge and cross-specialty knowledge was highlighted as well as the ability to 'make a difference to patients' lives'. Nephrologists enjoyed the challenge of managing very sick, acutely unwell patients as well as the holistic continuity of long-term care offered to dialysis patients and their families. Academic and procedural components were attractive motivators to the specialty and the flexibility to have multiple interests was noted, with many nephrologists having 'portfolio' careers. Based on these results, we suggest strategies the specialty can use to aid policy decision making, promote recruitment and improve educational experiences within current training programmes.
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Affiliation(s)
- Hannah Beckwith
- Nephrology Registrar, MRC London Institute of Medical Science, Imperial College London, London, UK
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
- Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Martyn Kingsbury
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Jo Horsburgh
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
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21
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Miller A, Fleet Z. The future of internal medicine: a new curriculum for 2019. Br J Hosp Med (Lond) 2018; 79:225-228. [DOI: 10.12968/hmed.2018.79.4.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A new 3-year curriculum for training in internal medicine was approved by the General Medical Council in December 2017. This will replace core medical training in August 2019. It mandates specific experiences and introduces a novel assessment strategy that hopefully will lessen the perceived ‘burden of assessment’ on trainees (and trainers). It is hoped that it will improve the experience of and enthusiasm for training in internal medicine.
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Affiliation(s)
- Alastair Miller
- Chair of Internal Medicine Committee and Deputy Medical Director, Joint Royal Colleges of Physicians Training Board, London NW1 4LE
| | - Zoë Fleet
- Curriculum and Assessment Manager, Joint Royal Colleges of Physicians Training Board, London
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22
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Humphries N, Crowe S, Brugha R. Failing to retain a new generation of doctors: qualitative insights from a high-income country. BMC Health Serv Res 2018; 18:144. [PMID: 29486756 PMCID: PMC5830046 DOI: 10.1186/s12913-018-2927-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, particularly for low-income, source countries. In the past decade, Ireland has doubled the number of doctors it trains annually, but because of its failure to retain doctors, it remains heavily reliant on internationally trained doctors to staff its health system. To halve its dependence on internationally trained doctors by 2030, in line with World Health Organisation (WHO) recommendations, Ireland must become more adept at retaining doctors. METHOD This paper presents findings from in-depth interviews conducted with 50 early career doctors between May and July 2015. The paper explores the generational component of Ireland's failure to retain doctors and makes recommendations for retention policy and practice. RESULTS Interviews revealed that a new generation of doctors differ from previous generations in several distinct ways. Their early experiences of training and practice have been in an over-stretched, under-staffed health system and this shapes their decision to remain in Ireland, or to leave. Perhaps as a result of the distinct challenges they have faced in an austerity-constrained health system and their awareness of the working conditions available globally, they challenge the traditional view of medicine as a vocation that should be prioritised before family and other commitments. A new generation of doctors have career options that are also strongly shaped by globalisation and by the opportunities presented by emigration. DISCUSSION Understanding the medical workforce from a generational perspective requires that the health system address the issues of concern to a new generation of doctors, in terms of working conditions and training structures and also in terms of their desire for a more acceptable balance between work and life. This will be an important step towards future-proofing the medical workforce and is essential to achieving medical workforce self-sufficiency.
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Affiliation(s)
- Niamh Humphries
- Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, Ireland
- Present Address: Research Department, Royal College of Physicians of Ireland (RCPI), Frederick House, 19 South Frederick Street, Dublin 2, Ireland
| | - Sophie Crowe
- Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, Ireland
| | - Ruairí Brugha
- Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, Ireland
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23
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Fisher JM, Garside MJ, Brock P, Gibson V, Hunt K, Briggs S, Gordon AL. Why geriatric medicine? A survey of UK specialist trainees in geriatric medicine. Age Ageing 2017; 46:672-677. [PMID: 28164214 DOI: 10.1093/ageing/afx009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background there is concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field-in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective to explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design an online survey was sent to all UK higher medical trainees in geriatric medicine. Methods survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results two hundred and sixty-nine responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions there are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take.
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Affiliation(s)
- James Michael Fisher
- Department of Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Mark J Garside
- Department of Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Peter Brock
- Department of Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Vicky Gibson
- Department of Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Kelly Hunt
- Department of Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sally Briggs
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Adam Lee Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
- School of Health Sciences, City University, London, UK
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Fisher J, Garside M, Brock P, Gibson V, Hunt K, Wyrko Z, Gordon AL. Being the 'med reg': an exploration of junior doctors' perceptions of the medical registrar role. J R Coll Physicians Edinb 2017; 47:70-75. [PMID: 28569288 DOI: 10.4997/jrcpe.2017.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The role of the medical registrar is challenging and acknowledged as being a disincentive to a career in medicine for some junior doctors. We set out to build a broader understanding of the role through exploration of Foundation Doctors' and Core Medical Trainees' perceptions of the role. Data, gathered from focus groups, were analysed using a framework approach. Six key themes were identified, which were grouped under the headings 'perceptions of the medical registrar role' and 'transition into the role'. Our work builds on existing literature to inform a deeper understanding of how junior doctors perceive the medical registrar role. In light of our findings we offer suggestions on possible training initiatives to tackle the issues identified. We also highlight positive perceptions of the role and emphasise the key ambassadorial role that current medical registrars have in relation to attracting tomorrow's medical registrars to the specialty.
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Affiliation(s)
- J Fisher
- J Fisher, North Tyneside General, Hospital, Rake Lane, North Shields NE29 8NH, UK. drjamesfi
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Tavabie O. Consultant job planning for a 7-day service. Future Healthc J 2017; 4:150. [PMID: 31098455 PMCID: PMC6502616 DOI: 10.7861/futurehosp.4-2-150a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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26
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Anyiam O, Mercer C, Zaheen H. Participation in teaching opportunities during core medical training: barriers and enablers. Future Healthc J 2017; 4:86-91. [PMID: 31098441 PMCID: PMC6502620 DOI: 10.7861/futurehosp.4-2-86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The development of teaching ability is an essential part of the core medical training curriculum. Delivering teaching for foundation trainees is one way to achieve this while also enhancing the training of junior colleagues, yet there is no current evidence that this occurs. This study describes the extent to which core medical trainees in a UK training region are teaching juniors and identifies potential influencing factors. Questionnaires were completed by 61 core medical trainees and 20 of these participated in five focus groups. Participants had delivered a median number of two training sessions; however, 36% had not delivered any. Focus group data suggested a clear interest in involvement, but barriers such as lack of time and lack of encouragement inhibited this. Although there is a wealth of potential opportunities to teach juniors, this study suggests these are not being fully utilised by core medical trainees. Measures have been proposed to help overcome the identified barriers.
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Wright RJ, Howard EJ, Newbery N, Gleeson H. 'Training gap' - the present state of higher specialty training in adolescent and young adult health in medical specialties in the UK. Future Healthc J 2017; 4:80-95. [PMID: 31098440 PMCID: PMC6502624 DOI: 10.7861/futurehosp.4-2-80] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Young people often experience worse health outcomes and more dissatisfaction with healthcare compared with other age groups. This survey sought to determine the state of adolescent and young adult health training across medical specialties in the UK. An online questionnaire was distributed to higher specialty trainees in adult medical specialties. Training in adolescent/young adult health/transition was rated as minimal/non-existent by 70/73% of respondents, respectively; 52% reported that they had received no formal training and 61% had never attended a dedicated young person's or transition clinic. The most significant barrier to delivering good adolescent and young adult healthcare was felt to be lack of training to deal with adolescent issues. This survey has identified a 'training gap'; a lack of preparation to meet the specific care needs of the adolescent and young adult population. Improved interventions are required to help drive improvement in care for young people in the UK.
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Affiliation(s)
| | | | - Nina Newbery
- Medical Workforce Unit, Royal College of Physicians, London, UK
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28
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Gowland EH, Birns J, Bryant C, Ball KL. Trials and tribulations of the annual review of competence progression - lessons learned from core medical training in London. Future Healthc J 2017; 4:92-98. [PMID: 31098442 PMCID: PMC6502634 DOI: 10.7861/futurehosp.4-2-92] [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: 11/27/2022]
Abstract
The annual review of competence progression (ARCP) was introduced as a way of keeping records and reviewing satisfactory progress through a medical curriculum for doctors in training. It provides public assurance that doctors are trained to a satisfactory standard and are fit for purpose. A routine external review of the core medical training (CMT) ARCPs in London revealed documentation of satisfactory progression of trainees to the next level of training without the evidence to support their completion of the curriculum. An internal review and series of process interventions were subsequently conducted and implemented to improve the quality and standardisation of the ARCPs. This paper reviews these interventions, discusses the lessons learned from the internal review and highlights issues applicable to any ARCP process.
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King N, Zhu C. Improving Outpatient Clinic Experience for Core Medical Trainees. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu221836.w8226. [PMID: 28469891 PMCID: PMC5387956 DOI: 10.1136/bmjquality.u221836.w8226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/21/2017] [Indexed: 11/04/2022]
Abstract
Outpatient clinic experience is an important component of core medical training. Trainees are expected to attend up to 40 clinics, with a minimum requirement of 24, over the two-year programme. 1 Yet on a local and national level they have reported difficulties with attending even the minimum number of clinics, largely due to ward commitments and service demands. 5 A survey of local core medical trainees revealed a baseline mean clinic attendance of 0.5 clinics per month, with only 13% of trainees having attended the minimum number of clinics. The project aimed to increase the mean clinic attendance to one clinic per month, which would enable trainees to meet their curriculum requirements. Clinic attendance data was collected from core medical trainees at two-monthly intervals, to coincide with rotation changeover. The problem was initially discussed at our local medical faculty meeting and interventions were proposed. Firstly, an up to date clinic timetable was distributed and consultants encouraged to invite their trainees to clinic. Subsequently a clinic booking system was implemented, to enable trainees to arrange protected time in which to attend outpatient clinics. This intervention was unsuccessful in improving clinic attendance. A revised system of pre-allocating protected clinic time was therefore devised and implemented, which resulted in an increase in clinic attendance figures to above the target. Trainees have been allocated clinic days for the rest of the year, which should enable them to meet their curriculum requirements. Through the use of PDSA cycles, we were able to rapidly determine the effect of our interventions and make improvements that have led to an increase in trainee clinic attendance. This is a sustainable model that could be easily implemented by other hospital trusts for core medical trainees.
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Smallwood N, Goh YY. From revered to commiserated: the changing role of the medical registrar. Future Hosp J 2017; 4:53-55. [PMID: 31098288 DOI: 10.7861/futurehosp.4-1-53] [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: 11/27/2022]
Abstract
The role of the medical registrar has changed significantly over the last few years, and in many respects this has not been for the better. Both the perception and the realities of the general internal medicine component of higher specialist training have led to significant pressures on recruitment to specialty training posts. Core trainees do not feel prepared to become the medical registrar and those in the role highlight substantial problems that impact on the quality of care they can deliver. This article aims to explore some of these difficulties and where possible suggest potential solutions; there needs to be urgent action undertaken to stave off a potential crisis in registrar recruitment and retention. Despite this, the role of the medical registrar remains a hugely fulfilling part of a physician's career, and there is much to be celebrated and embraced about the qualities a registrar brings to the successful functioning of both general and specialist medical teams.
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Abstract
In 2013, the Royal College of Physicians published The medical registrar: empowering the unsung heroes of patient care. This report showed that workload, teamwork, training and flexibility were the key factors in determining job satisfaction and morale for medical registrars. Since the report, some progress has been made in each of these four areas. Reduction in workload by development of new parts of the hospital workforce has started and the junior doctors' industrial action has forced the NHS and employers to look afresh at both workload and training aspects. The creation of chief registrars and guardians of safe working has started to create a supporting framework to improve professional working lives and training. Teamwork and support from consultants is perhaps the biggest opportunity to improve matters. However, the NHS remains inflexible and making the medical registrar post attractive to those in earlier stages of training is the biggest challenge.
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32
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Yousuf F. Why do doctors choose to leave core medical training? Postgrad Med J 2016; 92:742. [DOI: 10.1136/postgradmedj-2016-134445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Blake T, Whallett A. Leadership and the medical registrar: how can organisations support these unsung heroes? Postgrad Med J 2016; 92:735-740. [PMID: 27708005 DOI: 10.1136/postgradmedj-2016-134262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/02/2016] [Accepted: 09/13/2016] [Indexed: 11/03/2022]
Abstract
Medical registrars have been described as the 'workhorses' of National Health Service hospitals, being at the interface of acute and chronic health services. They are expected to demonstrate effective leadership skills. There are concerns from the Royal College of Physicians that medical registrars are being overwhelmed and unsupported by organisations, and are struggling in their ability to provide safe, high-quality patient care. Junior colleagues are also being deterred by general medical specialties by the prospect of becoming the 'Med Reg'. There is a growing need to support medical registrars in several key aspects of training, not least medical leadership. Thus far, there has been a distinct disparity in the provision of medical leadership training for junior doctors in the UK that has adversely affected the standard of care given to patients. Recent landmark reviews and initiatives, principally the Medical Leadership Competency Framework, have raised awareness of leadership competencies for all doctors and the need for their incorporation into undergraduate and postgraduate curricula. It is hoped that interactive strategies to engage medical registrars in leadership training will lead to positive results including improvements in interdisciplinary communication, patient outcomes and fulfilment of curriculum competencies. Organisations have a duty to improve the quality of medical leadership training so that doctors feel equipped to influence change throughout their careers and be tomorrow's leaders. This review outlines the deficiencies in training, the importance of developing leadership skills in medical registrars and educational strategies that could be implemented by organisations in a cost-effective manner.
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Affiliation(s)
- Tim Blake
- Rheumatology Department, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Whallett
- Rheumatology Department, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
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Gowland E, Ball KL, Bryant C, Birns J. Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London. Clin Med (Lond) 2016; 16:427-431. [PMID: 27697803 PMCID: PMC6297300 DOI: 10.7861/clinmedicine.16-5-427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects.
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Affiliation(s)
- Emily Gowland
- School of Medicine, Health Education England, London, UK
| | - Karen Le Ball
- School of Medicine, Health Education England, London, UK
| | | | - Jonathan Birns
- School of Medicine, Health Education England, London, UK
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Patel P. An evaluation of the current patterns and practices of educational supervision in postgraduate medical education in the UK. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:205-14. [PMID: 27488852 PMCID: PMC4978634 DOI: 10.1007/s40037-016-0280-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/26/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Globally, clinical supervision has been widely adopted and studied. But in the UK, another variant of supervision has developed in the form of educational supervision. The quality of supervision remains highly variable and inadequate time, investment and guidance hinders its ability to actually benefit trainees. Therefore, undertaking a detailed study of the patterns and practices in educational supervision to inform developments in supervisory practice would be extremely beneficial. METHODS In this mixed methods study, educational supervisors and trainees working within a large London Trust were surveyed online about their experiences of educational supervision. In addition, observations of supervision sessions with a small group of supervisor and trainee pairs followed-up by semi-structured interviews were conducted. The quantitative data were analyzed using statistical software via descriptive statistics. The qualitative data underwent thematic framework analysis. RESULTS Both the qualitative and quantitative data revealed that whilst most junior doctors and supervisors value the ideal of educational supervision as a process for engaging in mentoring dialogues, it can become a tick box exercise, devaluing its usefulness and purpose. Trainees highlighted the need for more frequent formal meeting along with better preparation by supervisors. Supervisors would appreciate more support from trusts to help them enhance supervision for trainees. CONCLUSION The effectiveness of educational supervision can be improved with trainees and supervisors engaging in meaningful preparation and proactive communication before meetings. During these formal meetings, improving the quality of feedback and ensuring that regular mentoring dialogues occurred would be highly valuable.
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Affiliation(s)
- Priyank Patel
- Centre for Medical Education, Barts and the London, School of Medicine and Dentistry, London, UK.
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36
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Corcoran JP, Hallifax RJ, Talwar A, Psallidas I, Rahman NM. Safe site selection for chest drain insertion by trainee physicians - Implications for medical training and clinical practice. Eur J Intern Med 2016; 28:e13-5. [PMID: 26522378 DOI: 10.1016/j.ejim.2015.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom.
| | - Robert J Hallifax
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom; Department of Respiratory Medicine, Buckinghamshire Hospitals NHS Trust, Aylesbury, United Kingdom
| | - Ambika Talwar
- University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom; Department of Respiratory Medicine, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; University of Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
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Makris GC, Trigkidis KK, Apiranthiti K, Malietzis G, Alexiou VG, Falagas ME. Medical training in Greece: A crisis in progress. Postgrad Med 2015. [DOI: 10.1080/00325481.2015.1069167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Corcoran JP, Hallifax RJ, Talwar A, Psallidas I, Sykes A, Rahman NM. Intercostal chest drain insertion by general physicians: attitudes, experience and implications for training, service and patient safety. Postgrad Med J 2015; 91:244-50. [PMID: 25841231 DOI: 10.1136/postgradmedj-2014-133155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/09/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intercostal chest drain (ICD) insertion is considered a core skill for the general physician. Recent guidelines have highlighted the risks of this procedure, while UK medical trainees have reported a concurrent decline in training opportunities and confidence in their procedural skills. OBJECTIVES We explored clinicians' attitudes, experience and knowledge relating to pleural interventions and ICD insertion in order to determine what changes might be needed to maintain patient safety and quality of training. METHODS Consultants and trainees delivering general medical services across five hospitals in England were invited to complete a questionnaire survey over a 5-week period in July and August 2014. RESULTS 117 general physicians (32.4% of potential participants; comprising 31 consultants, 48 higher specialty trainees, 38 core trainees) responded. Respondents of all grades regarded ICD insertion as a core procedural skill. Respondents were asked to set a minimum requirement for achieving and maintaining independence at ICD insertion; however, only 25% of higher specialty trainees reported being able to attain this self-imposed standard. A knowledge gap was also revealed, with trainees managing clinical scenarios correctly in only 51% of cases. CONCLUSIONS Given the disparity between clinical reality and what is expected of the physician-in-training, it is unclear whether ICD insertion can remain a core procedural skill for general physicians. Consideration should be given to how healthcare providers and training programmes might address issues relating to clinical experience and knowledge given the implications for patient safety and service provision.
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Affiliation(s)
- John P Corcoran
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Robert J Hallifax
- Department of Respiratory Medicine, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Ambika Talwar
- Department of Respiratory Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Ioannis Psallidas
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Annemarie Sykes
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
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Lagan J, Cutts L, Zaidi S, Benton I, Rylance J. Are we failing our trainees in providing opportunities to attain procedural confidence? Br J Hosp Med (Lond) 2015; 76:105-8. [PMID: 25671476 DOI: 10.12968/hmed.2015.76.2.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Practical procedures play a crucial role in clinical outcome. High proportions of Mersey trainees report a lack of procedural confidence despite the fact that the majority want to perform more procedures. Training has to be carefully analysed to address these shortcomings.
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Affiliation(s)
- Jakub Lagan
- Registrar in the Department of Cardiology, Arrowe Park Hospital, Wirral CH49 5PE
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Tasker F, Dacombe P, Goddard AF, Burr B. Improving core medical training--innovative and feasible ideas to better training. Clin Med (Lond) 2014; 14:612-7. [PMID: 25468846 PMCID: PMC4954133 DOI: 10.7861/clinmedicine.14-6-612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A recent survey of UK core medical training (CMT) training conducted jointly by the Royal College of Physicians (RCP) and Joint Royal College of Physicians Training Board (JRCPTB) identified that trainees perceived major problems with their training. Service work dominated and compromised training opportunities, and of great concern, almost half the respondents felt that they had not been adequately prepared to take on the role of medical registrar. Importantly, the survey not only gathered CMT trainees' views of their current training, it also asked them for their 'innovative and feasible ways to improve CMT'. This article draws together some of these excellent ideas on how the quality of training and the experience of trainees could be improved. It presents a vision for how CMT trainees, consultant supervisors, training programme directors, clinical directors and managers can work together to implement relevant, feasible and affordable ways to improve training for doctors and deliver the best possible care for patients.
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Affiliation(s)
| | | | | | - Bill Burr
- Joint Royal College of Physicians Training Board, London, UK
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