Reforming medical education in the United Kingdom: lessons for Australia and New Zealand

Medical education faces global challenges because of the changing health care needs of an ageing and more demanding society, and the consequent requirement for increased health care workforce capacity and different workforce models. In the United Kingdom, education reform has spanned the medical, nursing and allied health professions, and has introduced new health professions with specific roles within a new, team-based model of comprehensive health care. In medical education, the UK reforms span undergraduate, prevocational, vocational and continuing education, with the aim of providing a framework for faster, more flexible career development that can adapt to future changes in workforce need. While some reforms are controversial, most appear sensible and are supported by most observers. The Modernizing Medical Careers process suffered implementation difficulties in 2007: the national, web-based application scheme for vocational training posts could not cope with such a large process, disrupting both the recruitment of an appropriate workforce for hospitals and the career progression of many recent UK medical graduates. The main problem appears to have been in management of change--too much was attempted too quickly on too large a scale--resulting in a backlash against any significant change. There may be lessons for Australia and New Zealand, which face similar challenges and are considering broadly similar changes

Insight into rural and remote GP training and supervision in Queensland

Many rural and remote communities are struggling to attract and retain GPs while experiencing poorer population health outcomes and burden of disease. Therefore, the provision of a reliable rural GP workforce is vital. Registered Training Organisations provide high quality training experiences for GP registrars. A collaborative project between JCU and Monash University aimed to identify aspects of GP training which impact registrars’ experience. Perspectives were obtained from GP registrars, supervisors, and practice managers. This presentation focuses on training and supervision aspects in rural and remote north-west Queensland. A mixed methods study was undertaken and both quantitative and qualitative data were collected. A modified survey based on the adapted Critical Access Hospital Community Apgar Questionnaire was used to collect data about perceptions of rural GP training and supervision with the highest rated factor being medical quality and the lowest rated being scope of practice. Semi-structured interviews were then used to gather additional information about training and supervision experiences. Interviews were thematically analysed and primary themes relating to attractors and barriers for workforce training and supervision, and impact of rural remote practice were elicited. Attractors included lifestyle, rural medicine, scope of practice, services and incentives while barriers included workforce factors, lifestyle, location, services and incentives. Rural remote GP training experiences contribute a variety of attractors and barriers which impact on a positive training experience for registrars. Identification of these factors make it possible to tailor training accordingly and foster a positive rural experience that may translate to a future reliable workforce

Understanding medical students' transformative experiences of early pre-clinical international rural placement over a 20-year period

Introduction Rural placements are an important component of rural medical education programs seeking to develop rural practice pathways for medical students. These placements are usually domestic, but James Cook University in Australia developed an international rural placement program in the first half of the medical course that was funded through bursaries. This study explores how the international rural placement helped to shape the lives (personal development and learning) of the participants, using Transformational Learning Theory as a framework for identifying and describing the transformational elements, process and impact of the program. Methods Sixty-five students received a bursary for an international rural placement between 2001–2019. All were contacted by email and invited to participate in a short survey and a follow-up interview. Fifteen participants agreed and twelve were able to participate in individual semi-structured interviews which were recorded, transcribed and analysed using inductive thematic analysis. Results Participants reported that the bursary provided a “once in a lifetime opportunity” to “experience eye-opening and culturally rich difference”. Nonetheless, some elements of the placement experience presented disorientating dilemmas that triggered deep reflections and shifts in perceptions. The bursary recipients realised that “being open-minded” allowed them “enjoy good company”. They were also able to assume “outsider view which allowed reassessment of their own country” and the “isolation experiences gingered desire to right health wrongs”. The triggers and mental shifts had significant impact on the bursary recipients and fostered the development of “inspirational new horizons” based on an appreciation of the “value of rural practice” and “role-modelling for life-long learning.” These findings are consistent with Transformational Learning Theory. Conclusion Participants in this study reported meaningful and strongly positive impacts from the experiences gained during an international rural clinical placement early in their course. They described transformative experiences which appear to contribute strongly to personal development. This finding supports maintaining opportunities for international experiences during rurally-oriented medical programs as these may impact longer term career choice

“Could You Work in My Team?”: Exploring How Professional Clinical Role Expectations Influence Decision-Making of Assessors During Exit-Level Medical School OSCEs

Decision-making in clinical assessment, such as exit-level medical school Objective Structured Clinical Examinations (OSCEs), is complex. This study utilized an empirical phenomenological qualitative approach with thematic analysis to explore OSCE assessors' perceptions of the concept of a “prototypical intern” expressed during focus group discussions. Topics discussed included the concept of a prototypical intern, qualities to be assessed, and approaches to clinical assessment decision-making. The thematic analysis was then applied to a theoretical framework (Cultural Historical Activity Theory—CHAT) that explored the complexity of making assessment decisions amidst potentially contradicting pressures from academic and clinical perspectives. Ten Australasian medical schools were involved with 15 experienced and five less experienced assessors participating. Thematic analysis of the data revealed four major themes in relation to how the prototypical intern concept influences clinical assessors' judgements: (a) Suitability of marking rubric based on assessor characteristics and expectations; (b) Competence as final year student vs. performance as a prototypical intern; (c) Safety, trustworthiness and reliability as constructs requiring assessment and (d) Contradictions in decision making process due to assessor differences. These themes mapped well within the interaction between two proposed activity systems in the CHAT model: academic and clinical. More clinically engaged and more experienced assessors tend to fall back on a heuristic, mental construct of a “prototypical intern,” to calibrate judgements, particularly, in difficult situations. Further research is needed to explore whether consensus on desirable intern qualities and their inclusion into OSCE marksheets decreases the cognitive load and increases the validity of assessor decision making

Examiners\u27 decision‐making processes in observation-based clinical examinations

Background: Objective structured clinical examinations (OSCEs) are commonly used to assess the clinical skills of health professional students. Examiner judgement is one acknowledged source of variation in candidate marks. This paper reports an exploration of examiner decision making to better characterise the cognitive processes and workload associated with making judgements of clinical performance in exit‐level OSCEs. Methods: Fifty‐five examiners for exit‐level OSCEs at five Australian medical schools completed a NASA Task Load Index (TLX) measure of cognitive load and participated in focus group interviews immediately after the OSCE session. Discussions focused on how decisions were made for borderline and clear pass candidates. Interviews were transcribed, coded and thematically analysed. NASA TLX results were quantitatively analysed. Results: Examiners self‐reported higher cognitive workload levels when assessing a borderline candidate in comparison with a clear pass candidate. Further analysis revealed five major themes considered by examiners when marking candidate performance in an OSCE: (a) use of marking criteria as a source of reassurance; (b) difficulty adhering to the marking sheet under certain conditions; (c) demeanour of candidates; (d) patient safety, and (e) calibration using a mental construct of the \u27mythical [prototypical] intern\u27. Examiners demonstrated particularly higher mental demand when assessing borderline compared to clear pass candidates. Conclusions: Examiners demonstrate that judging candidate performance is a complex, cognitively difficult task, particularly when performance is of borderline or lower standard. At programme exit level, examiners intuitively want to rate candidates against a construct of a prototypical graduate when marking criteria appear not to describe both what and how a passing candidate should demonstrate when completing clinical tasks. This construct should be shared, agreed upon and aligned with marking criteria to best guide examiner training and calibration. Achieving this integration may improve the accuracy and consistency of examiner judgements and reduce cognitive workload

Cytoplasmic dynein nomenclature

A variety of names has been used in the literature for the subunits of cytoplasmic dynein complexes. Thus, there is a strong need for a more definitive consensus statement on nomenclature. This is especially important for mammalian cytoplasmic dyneins, many subunits of which are encoded by multiple genes. We propose names for the mammalian cytoplasmic dynein subunit genes and proteins that reflect the phylogenetic relationships of the genes and the published studies clarifying the functions of the polypeptides. This nomenclature recognizes the two distinct cytoplasmic dynein complexes and has the flexibility to accommodate the discovery of new subunits and isoforms

Tobacco Dependence Treatment Grants: A Collaborative Approach to the Implementation of WHO Tobacco Control Initiatives

The number of global tobacco-related deaths is projected to increase from about 6 million to 8 million annually by 2030, with more than 80% of these occurring in low- and middle-income countries (LMICs). The World Health Organization Framework Convention on Tobacco Control (FCTC) came into force in 2005 and Article 14 relates specifically to the treatment of tobacco dependence. However, LMICs, in particular, face several barriers to implementing tobacco dependence treatment. This paper is a descriptive evaluation of a novel grant funding mechanism that was initiated in 2014 to address these barriers. Global Bridges. Healthcare Alliance for Tobacco Dependence Treatment aims to create and mobilize a global network of healthcare professionals and organizations dedicated to advancing evidence-based tobacco dependence treatment and advocating for effective tobacco control policy. A 2014 request for proposals (RFP) focused on these goals, particularly in LMICs, where funding for this work had been previously unavailable. 19 grants were awarded by Global Bridges to organizations in low- and middle-income countries across all six WHO regions. Virtually all focused on developing a tobacco dependence treatment curriculum for healthcare providers, while also influencing the political environment for Article 14 implementation. As a direct result of these projects, close to 9,000 healthcare providers have been trained in tobacco dependence treatment and an estimated 150,000 patients have been offered treatment. Because most of these projects are designed with a “train-the-trainer” component, two years of grant funding has been a tremendous catalyst for accelerating change in tobacco dependence treatment practices throughout the world. In order to foster such exponential growth and continue to maintain the impact of these projects, ongoing financial, educational, and professional commitments are required

Finding robust solutions for constraint satisfaction problems with discrete and ordered domains by coverings

Constraint programming is a paradigm wherein relations between variables are stated in the form of constraints. Many real life problems come from uncertain and dynamic environments, where the initial constraints and domains may change during its execution. Thus, the solution found for the problem may become invalid. The search forrobustsolutions for constraint satisfaction problems (CSPs) has become an important issue in the ¿eld of constraint programming. In some cases, there exists knowledge about the uncertain and dynamic environment. In other cases, this information is unknown or hard to obtain. In this paper, we consider CSPs with discrete and ordered domains where changes only involve restrictions or expansions of domains or constraints. To this end, we model CSPs as weighted CSPs (WCSPs) by assigning weights to each valid tuple of the problem constraints and domains. The weight of each valid tuple is based on its distance from the borders of the space of valid tuples in the corresponding constraint/domain. This distance is estimated by a new concept introduced in this paper: coverings. Thus, the best solution for the modeled WCSP can be considered as a most robust solution for the original CSP according to these assumptionsThis work has been partially supported by the research projects TIN2010-20976-C02-01 (Min. de Ciencia e Innovacion, Spain) and P19/08 (Min. de Fomento, Spain-FEDER), and the fellowship program FPU.Climent Aunés, LI.; Wallace, RJ.; Salido Gregorio, MA.; Barber Sanchís, F. (2013). Finding robust solutions for constraint satisfaction problems with discrete and ordered domains by coverings. Artificial Intelligence Review. 1-26. https://doi.org/10.1007/s10462-013-9420-0S126Climent L, Salido M, Barber F (2011) Reformulating dynamic linear constraint satisfaction problems as weighted csps for searching robust solutions. 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The systematic development of a novel integrated spiral undergraduate course in general practice

In 2007 Keele University School of Medicine rolled out its novel curriculum to which general practice makes a major contribution. In this paper we describe the systematic approach we took to developing the GP curriculum; from the underlying educational principles which guided its development, the subsequent decisions we made to the curriculum itself. This consists of 23 weeks of clinical placements in general practice; four weeks in year 3, four weeks in year 4 and 15 weeks in year 5. We describe the steps which were necessary to prepare for the implementation of the GP curriculum. We consider that the successful implementation of our general practice contribution is a result of our systematic identification of these principles, the clearly articulated design decisions and the systematic preparation for implementation involving the academic GP team and all our potential teaching practices

A life in progress: motion and emotion in the autobiography of Robert M. La Follette

This article is a study of a La Follette’s Autobiography, the autobiography of the leading Wisconsin progressive Robert M. La Follette, which was published serially in 1911 and, in book form, in 1913. Rather than focusing, as have other historians, on which parts of La Follette’s account are accurate and can therefore be trusted, it explains instead why and how this major autobiography was conceived and written. The article shows that the autobiography was the product of a sustained, complex, and often fraught series of collaborations among La Follette’s family, friends, and political allies, and in the process illuminates the importance of affective ties as well as political ambition and commitment in bringing the project to fruition. In the world of progressive reform, it argues, personal and political experiences were inseparable