Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies

Background: The notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential. Objectives This study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care. Methods A multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland. Results The evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented. Limitations The use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth. Conclusions At a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Developing chiropractic students clinical practice skills - elements of best practice : a qualitative exploratory descriptive study

Background Although chiropractic has 125 years as an established profession, scrutiny of the literature proves that few studies have examined the clinical education of chiropractic students with a call for research from academics. This thesis is significant as it develops knowledge that can inform chiropractic bodies and help them improve an essential component of chiropractic education: clinical skill development. Research Purpose and Aims The purpose of this study was to identify elements of best practices in clinical education by critically examining, exploring and describing the aspects of an exemplar chiropractic clinical program that develops students’ clinical practice skills for transition into practice. This study explored the innovative clinical program of a reputable American chiropractic institution providing a scaffolded clinical program across varied clinical settings, patient populations and amongst other health disciplines. Research Design A six-phase exploratory descriptive qualitative design (EDQD) study was conducted to explore and describe the phenomenon being examined (Flick, 2014). This design enabled the collection of information about perceptions and lived experiences of three stakeholder cohorts: clinical faculty members, students and new graduates. Methods Purposive sampling (of students and clinical faculty members) and snowball sampling techniques (of new graduates) were used to derive the sample. Data were collected in three cycles across a two-year period using in-depth, semi-structured interviews. Interviews were conducted with 15 clinical faculty members and eight new graduates, and semi-structured focus groups were conducted with 20 students. All data were audio recorded, transcribed and thematically analysed using an inductive approach. Findings Chiropractic clinical education programs ought to be developed within a framework that incorporates adult learner principles; situated, social and experiential learning theories. Valued was a student-centred learning experience that includes authentic and diverse clinical placements, supervision and mentoring from multiple clinical educators which enhances students’ access to varied perspectives of clinical practices that contributes to developing clinical skills and professional identity. Business knowledge and entrepreneurial skills was an area of deficiency, which is problematic when the objective is to build graduates’ independence in clinical practice and professional prospects are predominantly private practice (NBCE, 2020). Embedding evidence-based practice within curricula and clinical training for educators and students are necessary to ensure this becomes a part of clinical practice. Conclusion This thesis posits best practice in chiropractic clinical education consists of the following: (a) using a scaffolded longitudinal clinical program, (b) varying clinical placements and case mix, (c) supervision and mentoring from multiple clinical educators, (d) educating the clinical educator, (e) curricula designed around industry standards and desired graduate attributes and capabilities, (f) an evidence-based practice approach in the curricula and clinical context, (g) aligning business skills, knowledge and practices with the professional context and (h) interprofessional learning and practice opportunities. Although this study has made a contribution to scholarly discourse, there remain many gaps in our knowledge where further studies are needed.Doctor of Philosoph

P16. Introducing Peer Physical Examination

We are a new medical school (now into our eighth year) and until the 2008/09 academic year our Year One and Two students acquiredphysical examination skills by examining healthy volunteers. The Year One cohort in 2008/09 were the first to acquire these skills using Peer Physical Examination (PPE), performing the examinations on each other, and this was rolled out to involve all Year One and Twostudents this academic year.Introducing PPE involved a culture shift within the medical school, training of existing and new tutors and revisions to our written studyguide material.Over the past eighteen months we have overcome several practical and ideological challenges during the introduction of PPE as a teaching method.Our poster explains our teaching methods, the challenges encountered and the pragmatic ways in which we have navigated a course through these challenges at both an individual and organisational level. We are now able to give much clearer guidance to students and tutors with the benefit of what we have learntover the past 18 months

Workshop 07. Developing approaches to professionalism in medical students

Since the inception of our medical school seven years ago we have noticed that despite undergraduate medical students having an awareness that doctors have expected professional behaviours they have not always appreciated how professional behaviour applies to medical students. Professionalism issues have arisen both within and outside the medical school. This has been particularly evident during the introduction three years ago of peer physical examination as a means for students to acquire physical examination skills.We have been able to address these issues in several ways - At an institutional level we have both been closely involved with supporting tutors and students as issues have arisen. Challenges that have arisen have informed tutor training –helping tutors to feel empowered to deal with issues themselves. Professionalism issues are addressed in staff development sessions covering acceptable behaviours and tutors are encouraged to draw on each other for advice. For example, we involved our tutors in the development of a session which involves case vignettes around appropriate behaviour in physical examination sessions. We have developed a highly effective process of peer observation within the tutor group. Existing tutors mentor new tutors. We are proud to have developed a group of experienced clinician tutors with diverse views who have collective ownership of the teaching process. On a practical level we have raised the ‘professionalism’ thread in the students’ learning experience – via lectures, written material and discussions. For example, one of the first lectures given to the first year students focuses on professionalism and its relevance to them within both clinical and non-clinical teaching sessions and also outside the medical school. One area that continues to challenge both students and tutors is that of cultural diversity and how this sits alongside expected professional behaviours

P15. Employing students' multilingualism and language diversity in teaching and learning

Before our innovative clinical skills session ‘Interpreting in Consultations’, we conducted an annual survey of languages spoken by students on admission, in 2006, 2007 and 2008. Froma response rate of 94% we noted that 28% of students are advanced/fluent speakers of language(s) other than English and a total of 48 languages are spoken.The session, ‘Interpreting in Consultations’, involves first and second year students who speak the same language other than English, role-playing an ‘interpreted’ consultation.Feedback from tutors and students following the session shows that using different languages serves multiple, valuable purposes, highlighting:• issues encountered with interpreters• challenges of ‘medical’ language• difficulties in transmitting a patient centred approach• how linguistic and cultural sensitivities are lost in translation.Student linguistic diversity is considerable and not used to its full potential: the single clinical skills session we report suggests there is much more to be gained. The education we design and delivermay fail to recognise what patient-centred-ness means in different languages and cultures.Future research should: consider how to make best use of multiculturalism and linguistic diversity; explore how students’ awareness of, and competence in, different languages and culturescan be developed and maintained

Italy: Health System Review

Presentazione e valutazione del sistema sanitario italiano commissionato al CERGAS e al Gemelli di Roma da parte della World Health Organization

Voices of Fermanagh : The removal of emergency general surgery from South West Acute Hospital

The purpose of this study is to examine the representation and communication among stakeholders affected by the removal of emergency general surgery (EGS) from South West Acute Hospital in Fermanagh, Northern Ireland. By using thematic analysis, this research explores public discussions, policy discourse, and media coverage to assess how different stakeholder groups - patients, healthcare professionals, policymakers, and community advocates - have been portrayed and engaged in the ongoing debate. The study aims to determine whether voices remain unheard, how stakeholder communication is perceived by others, and how public dialogue has evolved since the removal of emergency surgical services in November 2022. The findings may support healthcare policymakers and advocacy groups in understanding the impact of service reductions on public discourse and decision-making. The study is grounded in theories of healthcare accessibility, rural medical service centralization, stakeholder engagement, and trauma care networks. A qualitative thematic analysis was conducted using a total of 94 documents on public discussions, media articles and policy documents. The articles were from 15 sources, of which 11 are news platforms of local, regional and international coverage and the remaining 4 sources were government or service provider publications. The research analysed the thematic patterns, frequency of stakeholder inclusion, and perceived impacts of emergency general surgery removal. The findings suggest that government bodies and community members are well represented in the public discourse, however service providers and staff members are underrepresented or need advocating for in narrating experiences and as part of the decision-making process. The debate on the topic covered by the media demonstrates experiences of public distrust in decision-makers, existing policies and governance. Since November 2022, discussions have shifted from initial backlash and protests to policy negotiations and rural healthcare advocacy efforts. The study concludes that centralization of emergency surgical services disproportionately impacts rural communities, contributing to longer pre-hospital times and heightened health risks. Improved stakeholder engagement strategies - such as community-led consultations, increased media transparency, and healthcare literacy programs - are necessary to bridge the communication gap. The research recommends policy adjustments that prioritize rural health equity, ensure social accountability, and strengthen local decision-making processes. Keywords: stakeholder engagement, rural healthcare, trauma networks, emergency surgical service removal, Northern Ireland healthcare polic

Classifying simulators and simulations for extracorporeal membrane oxygenation (ECMO) - A review with a new framework on classifying fidelity

Introduction: Background, Context and AimsOutcomes of extracorporeal membrane oxygenation (ECMO) for cardiac or respiratory failure improve when performed with a suitable annual exposure to ECMO cases. High-volume ECMO centres are scarce, whereas simulation-based training (SBT) offers an addition to these low-volume centres for training and maintenance of skills, and to improve interdisciplinary team interactions. However, ECMO simulators and/or simulations (ECMO sims) techniques vary in purpose, and therefore their level of realism (fidelity). The necessary level of fidelity must be based on the intendedtraining outcome. Therefore, level of fidelity is not the same as quality of an ECMO sim.The aim is to develop a fidelity classification framework and objectively classify available ECMO sims by aninterdisciplinary panel of users and developers as low-, mid-, or high-fidelity.MethodsFidelity classification is based on a new framework consisting of overall ECMO sim fidelity, established by taking the median of the definition-based fidelity, component fidelity, and customization fidelity as determined by expert opinion. PRISMA (preferred reporting items for systematic reviews and meta-analyses) scoping guidelines were followed. Consensus was achieved on definitions, and ultimate classification.Results & DiscussionUntil October 2022, 30 ECMO sims were found, with 26 suitable for classification. According to this framework, all assessed ECMO sims only classified as low- or mid-fidelity. Most ECMO sims (54%) lacked patient customization, i.e. ECMO sims with different physical features as skin colour, sex, or amount of subcutaneous fat. This comparison method may be used in the future for the description of new developments in ECMO sims, making it possible for ECMO sim designers, users, and researchers to compare accordingly, and ultimately improve ECMO patient outcomes

The musculoskeletal learning needs of doctors in training for general practice

General practitioners must be able to respond appropriately to the full range of medical conditions that present to them during their surgeries. To do this they require adequate training in a variety of specialties. Concerns have been raised regarding general practitioners training in certain areas. One of these is the management of musculoskeletal conditions. The overall aim of this study was to explore the musculoskeletal learning needs of trainee general practitioners by identifying the conditions they see during their day to day work and then asking them to reflect on these. A secondary aim was to create an educational package focused on one area of learning need and to evaluate this. A questionnaire study initially performed in 1995, which highlighted concerns regarding training in this area, was repeated to see if the situation had changed. Thereafter thirteen trainees kept a diary documenting all of their musculoskeletal consultations for a month. They were also asked to document any perceived learning needs regarding these consultations. The trainees were then interviewed and their identified learning needs were further explored. Any others learning needs in musculoskeletal medicine were also discussed. Focus groups with a further two groups of registrars were performed, along with interviews with eight trainers, in order to triangulate the data and to explore their ideas. An educational package on the management of shoulder pain, one of the areas identified by the trainees, was developed and trialled with a different group of doctors by using a pre- and post- knowledge test. Confidence in managing musculoskeletal disorders in doctors currently training for a career in general practice remains poor. Learning needs were identified in a variety of different areas. It is possible to create an educational package focused on a specific area which can address these needs.EThOS - Electronic Theses Online ServiceArthritis Research CampaignGBUnited Kingdo