Improving core medical training--innovative and feasible ideas to better training

Postgraduate medical procedural skills: attainment of curricular competencies using enhanced simulation-based mastery learning at a novel national boot camp

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.

Prepared for practice? UK Foundation doctors' confidence in dealing with ethical issues in the workplace

This paper investigates the medical law and ethics (MEL) learning needs of Foundation doctors (FYs) by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners' views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response.

Quality Criteria for Core Medical Training: A Resume of Their Development, Impact and Future Plans

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.

How Do Pharmacists Develop into Advanced Level Practitioners? Learning from the Experiences of Critical Care Pharmacists

The national UK standards for critical care highlight the need for clinical pharmacists to practise at an advanced level (equivalent to Royal Pharmaceutical Society, Great Britain, Faculty Advanced Stage II (MFRPSII)) and above. Currently the UK is unable to meet the workforce capacity requirements set out in the national standards in terms of numbers of pharmacist working at advanced level and above. The aim of this study was to identify the strategies, barriers and challenges to achieving Advanced Level Practice (ALP) by learning from the experiences of advanced level critical care pharmacists within the UK. Eight participants were recruited to complete semi-structured interviews on their views and experiences of ALP. The interviews were analysed thematically and three overarching themes were identified; support, work-based learning and reflective practice. The results of this study highlight that to increase the number of MFRPSII level practitioners within critical care support for their ALP development is required. This support involves developing face-to-face access to expert critical care pharmacists within a national training programme. Additionally, chief pharmacists need to implement drivers including in house mentorship and peer review programmes and the need to align job descriptions and appraisals to the Royal Pharmaceutical Society, Great Britain, Advanced Practice Framework (APF).

Being the 'med reg': an exploration of junior doctors' perceptions of the medical registrar role

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.

Participation in teaching opportunities during core medical training: barriers and enablers

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.

Training tomorrow's doctors

The ability of our NHS to deliver world-class compassionate care is dependent on the quality of training and education of our staff. We know that the path of moving from novice to expert is far from linear. Instead, it is a complex journey that is domain specific with multiple variations reflecting the individuality of our learners. Within this complex journey, there is a need to train the doctors of tomorrow to be humanistic, competent, patient-centred, resilient beings who will thrive in a challenging environment, striving to advance medicine. We discuss two models of curricula, the longitudinal integrated programmes and the internal medicine curriculum, which are proposed to address the healthcare needs of the UK population. In this article, we look at the opportunities that exist, the future potentials for medical education, and the challenges to overcome as we endeavour to create the best education models for physicians in the 21st century.