The expansion of medical education provision and widening access to study medicine in England

This PhD submission focuses on issues arising from the recent expansion of medical education in England, including widening access to medicine. It presents 11 papers published over the last 9 years which are the product of academic collaborations with colleagues and students at the University of Birmingham. The work includes outputs from local and national evaluations that have examined the expansion policy, process, and outcomes. Three research themes are identified from this body of papers; the first around predicted and observed impacts of expansion policy at local and national levels; the second concentrating on students’ and clinical teachers’ experiences of education amidst expanding provision; and finally issues relevant to widening access to medicine policy. The findings complement and add to existing knowledge in these research areas and give the basis to draw overarching conclusions about the significance of recent policy shifts for policy makers, medical schools, educators and students. In turn this work allows us to identify the need for further lines of enquiry and argues for a broad approach and conceptualisation for medical education research that is able to track macro policy changes, through meso level organisational and institutional influences, to micro level experience of educational policy and delivery

Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6

Objective To determine whether new programmes developed to widen access to medicine in the United Kingdom have produced more diverse student populations

Ensuring that the outcome domains proposed for use in burns research are relevant to adult burn patients:a systematic review of qualitative research evidence

Background There have been several attempts to define core outcome domains for use in research focused on adult burns. Some have been based in expert opinion, whilst others have used primary qualitative research to understand patients’ perspectives on outcomes. To date there has not been a systematic review of qualitative research in burns to identify a comprehensive list of patient-centred outcome domains. We therefore conducted a systematic review of qualitative research studies in adult burns. Methods We searched multiple databases for English-language, peer-reviewed, qualitative research papers. We used search strategies devised using the SPIDER tool for qualitative synthesis. Our review utilized an iterative three-step approach: (1) outcome-focused coding; (2) development of descriptive accounts of outcome-relevant issues; and (3) revisiting studies and the broader theoretical literature in order to frame the review findings. Results Forty-one articles were included. We categorized papers according to their primary focus. The category with the most papers was adaptation to life following burn injury (n = 13). We defined 19 outcome domains across the 41 articles: (1) sense of self; (2) emotional and psychological morbidity; (3) sensory; (4) scarring and scar characteristics; (5) impact on relationships; (6) mobility and range of joint motion; (7) work; (8) activities of daily living and self-care; (9) treatment burden; (10) engagement in activities; (11) wound healing and infection; (12) other physical manifestations; (13) financial impact; (14) impact on spouses and family members; (15) analgesia and side effects; (16) cognitive skills; (17) length of hospital stay; (18) access to healthcare; and (19) speech and communication. We suggest that sense of self is a core concern for patients that, to date, has not been clearly conceptualized in the burns outcome domain literature. Conclusions This outcome domain framework identifies domains that are not covered in previous attempts to outline core outcome domains for adult burn research. It does so with reference to existing theoretical perspectives from the sociology and psychology of medicine. We propose that this framework can be used as a basis to ensure that outcome assessment is patient-centred. Sense of self requires further consideration as a core outcome domain

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

Aim: The aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment.Methods: A Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch–Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content.Results: Fourteen sources were identified and assessed using the identified tools. The mean Flesch–Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch–Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources.Conclusions: The current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high-quality information, ideally co-produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia