The predictive validity of multiple mini interviews (MMIs) in nursing and midwifery programmes: year three findings from a cross-discipline cohort study

Education literature worldwide is replete with studies evaluating the effectiveness of Multiple Mini Interviews (MMIs) in admissions to medicine but <1% of published studies have been conducted in selection to nursing and midwifery programmes. To examine the predictive validity of MMIs using end of programme clinical and academic performance indicators of pre-registration adult, child, and mental health nursing and midwifery students. A cross-sectional cohort study at one university in the United Kingdom. A non-probability consecutive sampling strategy whereby all applicants to the September 2015 pre-registration adult, child, mental health nursing and midwifery programmes were invited to participate. Of the 354 students who commenced year one, 225 (64%) completed their three-year programme and agreed to take part (adult 120, child 32, mental health nursing 30 and midwifery 43). All applicants were interviewed using MMIs with six and seven station, four-minute models deployed in nursing and midwifery student selection respectively. Associations between MMI scores and the cross-discipline programme performance indicators available for each student at this university at the end of year three: clinical practice (assessed by mentors) and academic attainment (dissertation mark) were explored using multiple linear regression adjusting for applicant age, academic entry level, discipline and number of MMI stations. In the adjusted models, students with higher admissions MMI score (at six and seven stations) performed better in clinical practice (p < 0.001) but not in academic attainment (p = 0.122) at the end of their three-year programme. These findings provide the first report of the predictive validity of MMIs for performance in clinical practice using six and seven station models in nursing and midwifery programmes. Further evidence is required from both clinical and academic perspectives from larger, multi-site evaluations. [Abstract copyright: Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.

Values, situational judgement, and the clinical practice environment: A study of adult nursing students.

Background: In England, a Values Based Recruitment (VBR) policy intends to ensure that healthcare students’ individual values align with the values of the National Health Service (NHS) Constitution. However, students’ values may become compromised with increased clinical experience, due to, for instance, distress, negative role models and hidden curricula. Aim: To explore potential differences in values between first, second, and third year students of adult nursing, in order to theorise whether and how such students’ values may change over the duration of their programme, upon exposure to clinical practice environments. Objectives: 1. To develop an instrument (Situational Judgement Test, SJT) that assesses students’ congruence with the NHS Constitution values, and whether these are prioritised. 2. To establish whether the values (assessed using the SJT) of students with differing levels of experience (years one, two, and three – particularly clinical practice experience) vary. 3. To generate insights into the considerations and reflections that students have regarding SJT items, and determine whether these vary between the different year groups. 4. To verify and gain a deeper understanding of these findings in the context of students’ (practice) learning, as well as input for recommendations, through adult nursing Practice Liaison Tutors within the university. Methods: This research was granted a Favourable Ethical Opinion by the University of Surrey Ethics Committee. An SJT was developed (objective 1), and reliability and validity were determined with a pilot sample of 47 volunteers. Subsequently, first (n=13), second (n=15) and third (n=9) year students (total N=37) completed the SJT and participated in discussion sessions (objectives 2 and 3). Analysis took place using inferential statistics and thematic methods. Afterwards, six tutors were presented with the findings and interviewed (objective 4). Findings: SJT scores were highest in year one and lowest in year three (significant difference between first and third year group, F=7.28, p=.002). First year students expressed idealism. Second and third year students, however, experienced organisational hierarchy and difficulty speaking up against poor practice on their placements, at times de-prioritising the NHS Constitution values in response. Tutors could relate to these findings and suggested strategies to support students. Discussion: Despite the VBR policy, students’ congruence with the NHS Constitution values may become compromised with increased clinical experience. Recommendations are made for education and placement organisations to prepare students for clinical practice, address hierarchy, and provide a safe and ethical learning environment

What is the value of Values Based Recruitment for nurse education programmes?

Aim A discussion of issues associated with Values Based Recruitment for nurse education programmes. Background Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Design Discussion paper. Data Sources This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding Values Based Recruitment in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of Values Based Recruitment, underpinned by contemporary theory and literature. Implications for nursing Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how Values Based Recruitment will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of Values Based Recruitment methods. Conclusion We call for a debate regarding the meaning and implications of Values Based Recruitment and further research regarding its validity and effectiveness.<br /

What is the value of Values Based Recruitment for nurse education programmes?

Aim A discussion of issues associated with Values Based Recruitment for nurse education programmes. Background Values Based Recruitment is a mandatory element in selection processes of students for Higher Education healthcare courses in England, including all programmes across nursing. Students are selected on the basis that their individual values align with those presented in the Constitution of the National Health Service. However, there are issues associated with the use of values as selection criteria that have been insufficiently addressed. These are discussed. Design Discussion paper. Data Sources This article is based on documents published on the website of the executive body responsible for the implementation of a policy regarding Values Based Recruitment in Higher Education Institutions up until June 2017 and our evaluation of the conceptualisation of Values Based Recruitment, underpinned by contemporary theory and literature. Implications for nursing Values Based Recruitment influences who is accepted onto a nurse education programme, but there has been limited critical evaluation regarding the effectiveness of employing values as selection criteria. Values are subject to interpretation and evidence regarding whether or how Values Based Recruitment will improve practice and care is lacking. The issues discussed in this article show that Higher Education Institutions offering nursing courses, whether in England or in other countries, should be critical and reflective regarding the implementation of Values Based Recruitment methods. Conclusion We call for a debate regarding the meaning and implications of Values Based Recruitment and further research regarding its validity and effectiveness.<br /

NHS constitution values for values-based recruitment: a virtue ethics perspective

Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that ’integrity' and ’practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating ’integrity' and ’practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration

The "values journey" of nursing and midwifery students selected using multiple mini interviews; year two findings

Aim: To explore how adult, child, mental health nursing and midwifery students describe their “values journey” after completing their second year following exposure to the clinical practice environment. Background: Where student nurses and midwives are selected using multiple mini interviews, in a values‐based recruitment process, the conservancy and or development of their personal values remains unclear. Design: A hermeneutic, cross‐professional longitudinal study was commenced at one university in England in 2016 with data collection points at the end of years one (DC1), two (DC2) and three (DC3). From the 42 participants recruited in year one, 28 went on to participate in data collection at DC2 (3 adult, 6 child, 3 mental health nurses and 16 midwifery students). Methods: Four semi‐structured focus groups were conducted. Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Findings: Participants did not feel their values had changed fundamentally since year one. However, the prioritization of their values and how they were “put into practice” had changed. Key themes identified were: “changed sense of self as a healthcare practitioner”; “influences on values in practice” and “reflection on values.” Conclusion: Reframing of personal values is an integral part of learning across clinical and academic settings. Critical reflective practice should be integrated into preregistration health education programmes to support student nurses and midwives sustain their learning around values; to maintain “good” values in the face of observed “bad” values

Investigating the efficiency of lung multi‐disciplinary team meetings—A mixed methods study of eight lung multi‐disciplinary teams

Abstract Background Multidisciplinary team meetings (MDTMs), where treatment recommendations are discussed and agreed, are fundamental to effective cancer care. The increasing volume and complexity of caseloads has led to the need to transform MDTM pathways to improve efficiency and allow sufficient time for discussion of complex cases. Understanding of current functioning and inefficiencies is required to inform such transformation. Methods A mixed‐methods observational study of all lung cancer MDTMs in one UK cancer network over 12 weeks (n = 8 MDTs, 96 MDT meetings). Data were collected on meeting attendance and on each discussed case using a validated MDT tool. Semi‐structured interviews were conducted with a range of MDT members and cancer service managers to gain understanding of perceived influences on the efficiency of MDTMs. Results In total, 1671 case discussions were observed. Models of MDT working, including referral and diagnostic pathway management, varied within the network. Attendance was quorate in only 21% of the observed MDTMs, most often lacking palliative care specialists. Over a third (37%) of observed cases were repeat discussions pre‐diagnosis. Treatment recommendations were agreed in 48% of case discussions but deferred for a quarter (24%) of discussed cases, most commonly due to awaiting results. Information about patients' fitness for treatment and/or performance status score was available for 60% of cases discussed overall (30%–75% by MDT). Interviews (n = 56) identified addressing clinical and administrative workforce shortages, less reliance on the MDTM for pre‐diagnostic decision‐making and better availability of key clinical information about patients discussed in the MDTM as factors critical to improved MDT function. Conclusions Inefficiencies were prevalent in all MDTMs; improvements would require an individualised approach due to the variation in ways of working. Local, regional and national support is needed for lung MDTs to develop their diagnostic workforce and facilities, and clinical and administrative resource

Virtually the same? Examining the impact of the COVID-19 related shift to virtual lung cancer multidisciplinary team meetings in the UK National Health Service: a mixed methods study

Objectives To evaluate the impact of the shift to virtual lung cancer multidisciplinary team meetings (MDTMs) in response to the COVID-19 pandemic, specifically in relation to the magnitude of information technology (IT) issues and distractions and MDT members’/managers’ perceptions and experiences of this shift.Design A mixed methods study comprising real-time observations of IT issues/distractions within virtual MDTM case discussions held between April and July 2021 and qualitative data from interviews/surveys.Setting Eight hospital organisations in Southern England.Participants Team members (respiratory physicians, surgeons, oncologists, radiologists, pathologists, palliative care professionals, nurses and MDT coordinators) and managers (n=190) across 8 local MDTs.Results MDTM observations (n=1664) highlighted significant variation between teams regarding IT functionality. IT issues and other distractions relating to the virtual MDTM format were observed 465 times affecting 20.6% of case discussions, most of which were audio issues (18.1%). Case discussions that had audio issues were, on average, 26 s longer (t(1652)=−2.77, p&lt;0.01). A total of 73 MDT members and managers participated in the survey and 41 participated in interviews, with all 8 teams being represented. Increased flexibility, reduced travel time and easier real-time access to patient information were seen as the main advantages of virtual MDTMs. Views regarding the impact on relational aspects and communication differed. In line with observational findings, concerns were raised in relation to IT, including having inappropriate equipment, insufficient bandwidth (impairing image sharing and video communication) and an overarching theme that virtual meeting platforms provided were not fit for purpose.Conclusions Despite the potential benefits of virtual MDTMs, IT issues can waste valuable MDTM time. If hospital organisations plan to continue virtual MDTMs, a functioning infrastructure is required, necessitating appropriate resource and investment