Medical student learning during longitudinal clinical placements in under-served, deprived, community areas: A qualitative study

Background There are national UK general practitioner (GP) shortages, particularly in deprived areas, and an insufficient number of medical students intend to become GPs. Medical students currently have limited exposure to settings which provide care for deprived communities. This research investigates student learning during the Difficult and Deprived Areas Programme (DDAP), an innovative pilot programme which places fourth year students in general practice and community placements in under-served, post-industrial, deprived areas for 14 weeks. Method A systematic review investigating the efficacy of undergraduate community placements in under-served areas was completed. A qualitative approach was used collecting data from: DDAP students (n=9) before, during, and end of placement; GP supervisors (n=14), and patients (n=12). Comparison data was collected from peers taking alternative placements to the DDAP (n=16) and students taking an established rural programme (n=6). Semi-structured interviews were conducted to collect data. Data were analysed using framework analysis and the Experience Based Learning theory. Findings In total, 85 interviews were conducted over a two and a half year period. The DDAP experience enhanced student knowledge about psychosocial determinants of health, developed compassion, and reinforced clinical skills. Learning was facilitated through independent time with patients, which promoted deeper learning about the role of the doctor. The integrated and immersive DDAP structure gave students an understanding of delivering healthcare for patients with complex deprivation issues. Comparative placement experiences highlighted the importance of having a nurturing supportive supervisor and having an active role delivering healthcare within a community team. Conclusions There is increasing evidence on the value and importance of clinical placements in rural and remote communities, but little in regard to other under-served, deprived areas. This research explored medical student learning during an innovative placement in such a setting. The thesis provides evidence of the value of these placements and puts forward a model explaining why these placements are effective, and why they may help to create better doctors for the future

Educational Entrepreneurship: A New Challenge to Fiscal Equity?

The search for equity in public elementary and secondary education funding in the United States continues into the twenty-first century

Professional Identity Formation, Intersectionality and Equity in Medical Education

A great many factors interlink to produce barriers, opportunities and enablers at every stage of the education continuum that produce considerable potential for inequity.1,2 While one individual may receive privilege in terms of financial, support and educator guidance, the other may face financial hardship and discrimination in the journey to reach the same objective of being a healthcare practitioner. Even at an organizational level medical training dynamically constitutes many different models of education that help define the features of learners, setting the path for their future careers.3 The impact of this variety of experience has been particularly noticeable in 2020 as the events of the year in relation to under‐represented individuals have caused shockwaves throughout the world that have sharply called into question the ways in which health professional education addresses race and ethnic inequalities

Responsibility with a Safety Net:Exploring the Medical Student to Junior Doctor Transition During COVID-19

INTRODUCTION: The Foundation Interim Year-one (FiY1) Programme was part of a UK strategy to increase the medical workforce in response to the COVID-19 pandemic. However, the strategy was introduced urgently without evidence. We sought to explore the transition experience of medical student to FiY1 to foundation doctor, with a view to inform future undergraduate education. METHODS: In this hermeneutic phenomenology study, semi-structured individual interviews were completed with nine foundation doctors who had experience of an FiY1 placement. A template analysis approach was taken, and themes reported. RESULTS: Participants reported that FiY1 tended to offer a positive experience of transition as a stepping stone to becoming a foundation doctor. Having a degree of clinical responsibility including the right to prescribe medication with supervision was highly valued, as was feeling a core member of the healthcare team. Participants perceived that FiY1 made them more prepared for the foundation transition, and more resilient to the challenges they faced during their first foundation job. DISCUSSION: The FiY1 fostered many opportunities for junior doctors to bridge the transition to foundation doctor. Aspects of the FiY1 programme, such as early licencing and increased team membership, should be considered for final-year students in the future

Evidence synthesis on the occurrence, causes, consequences, prevention and management of bullying and harassment behaviours to inform decision making in the NHS

Background Workplace bullying is a persistent problem in the NHS with negative implications for individuals, teams, and organisations. Bullying is a complex phenomenon and there is a lack of evidence on the best approaches to manage the problem. Aims Research questions What is known about the occurrence, causes, consequences and management of bullying and inappropriate behaviour in the workplace? Objectives Summarise the reported prevalence of workplace bullying and inappropriate behaviour. Summarise the empirical evidence on the causes and consequences of workplace bullying and inappropriate behaviour. Describe any theoretical explanations of the causes and consequences of workplace bullying and inappropriate behaviour. Synthesise evidence on the preventative and management interventions that address workplace bullying interventions and inappropriate behaviour. Methods To fulfil a realist synthesis approach the study was designed across four interrelated component parts: Part 1: A narrative review of the prevalence, causes and consequences of workplace bullying Part 2: A systematic literature search and realist review of workplace bullying interventions Part 3: Consultation with international bullying experts and practitioners Part 4: Identification of case studies and examples of good practic

Realist evaluation of UK medical education quality assurance

OBJECTIVES: The aim of the study was to explore what components of the General Medical Council's (GMC) Quality Assurance Framework work, for whom, in what circumstances and how? SETTING: UK undergraduate and postgraduate medical education and training. PARTICIPANTS: We conducted interviews with a stratified sample of 36 individuals. This included those who had direct experiences, as well as those with external insights, representing local, national and international organisations within and outside medicine. INTERVENTION: The GMC quality assure education to protect patient and public safety utilising complex intervention components including meeting standards, institutional visits and monitoring performance. However, the context in which these are implemented matters. We undertook an innovative realist evaluation to test an initial programme theory. Data were analysed using framework analysis. RESULTS: Across components of the intervention, we identified key mechanisms, including transparent reporting to promote quality improvement; dialogical feedback; partnership working facilitating interactions between regulators and providers, and role clarity in conducting proportionate interventions appropriate to risk. The GMC's framework was commended for being comprehensive and enabling a broad understanding of an organisation's performance. Unintended consequences included confusion over roles and boundaries in different contexts which often undermined effectiveness. CONCLUSIONS: This realist evaluation substantiates the literature and reveals deeper understandings about quality assuring medical education. While standardised approaches are implemented, interventions need to be contextually proportionate. Routine communication is beneficial to verify data, share concerns and check risk; however, ongoing partnership working can foster assurance. The study provides a modified programme theory to explicate how education providers and regulators can work more effectively together to uphold education quality, and ultimately protect public safety. The findings have influenced the GMC's approach to quality assurance which impacts on all medical students and doctors in training

Understanding students' and clinicians' experiences of informal interprofessional workplace learning: An Australian qualitative study

Objectives While postgraduate studies have begun to shed light on informal interprofessional workplace learning, studies with preregistration learners have typically focused on formal and structured work-based learning. The current study investigated preregistration students' informal interprofessional workplace learning by exploring students' and clinicians' experiences of interprofessional student-clinician (IPSC) interactions. Design A qualitative interview study using narrative techniques was conducted. Setting Student placements across multiple clinical sites in Victoria, Australia. Participants Through maximum variation sampling, 61 participants (38 students and 23 clinicians) were recruited from six professions (medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy). Methods We conducted 12 group and 10 individual semistructured interviews. Themes were identified through framework analysis, and the similarities and differences in subthemes by participant group were interrogated. Results Six themes relating to four research questions were identified: (1) conceptualisations of IPSC interactions; (2) context for interaction experiences; (3) the nature of interaction experiences; (4) factors contributing to positive or negative interactions; (5) positive or negative consequences of interactions and (6) suggested improvements for IPSC interactions. Seven noteworthy differences in subthemes between students and clinicians and across the professions were identified. Conclusions Despite the results largely supporting previous postgraduate research, the findings illustrate greater breadth and depth of understandings, experiences and suggestions for preregistration education. Educators and students are encouraged to seek opportunities for informal interprofessional learning afforded by the workplace. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Kerry Hood” is provided in this record*

Detection of the Galaxy Lensing the Doubly-imaged Quasar SBS 1520+530

H band observations with a spatial resolution of 0.15" carried out with the Canada-France-Hawaii Telescope adaptive optics system show a galaxy between the components of the double BAL quasar SBS 1520+530, thereby confirming this system as a gravitational lens. The galaxy is located 0.40" from the fainter of the two QSO images and is offset 0.12" from the line joining them. The H magnitude of the lensing galaxy is ~1 mag fainter than expected from the velocity dispersion derived for the lensing galaxy were it at z = 0.71 or z = 0.81, the redshifts of the two absorption line systems.Comment: 11 pages latex including one table and 2 postscript figures. Corrected typo. Accepted by AJ. Also available at http://www.hia.nrc.ca/science/preprint/preprint.htm