Conceptualising and Teaching Biomedical Uncertainty to Medical Students: an Exploratory Qualitative Study

Introduction Certainty/uncertainty in medicine is a topic of popular debate. This study aims to understand how biomedical uncertainty is conceptualised by academic medical educators and how it is taught in a medical school in the UK. Methods This is an exploratory qualitative study grounded in ethnographic principles. This study is based on 10 observations of teaching sessions and seven semi-structured qualitative interviews with medical educators from various biomedical disciplines in a UK medical school. The data set was analysed via a thematic analysis. Results Four main themes were identified after analysis: (1) ubiquity of biomedical uncertainty, (2) constraints to teaching biomedical uncertainty, (3) the ‘medic filter’ and (4) fluid distinction: core versus additional knowledge. While medical educators had differing understandings of how biomedical uncertainty is articulated in their disciplines, its presence was ubiquitous. This ubiquity did not translate into teaching due to time constraints and assessment strategies. The ‘medic filter’ emerged as a strategy that educators employed to decide what to include in their teaching. They made distinctions between core and additional knowledge which were defined in varied ways across disciplines. Additional knowledge often encapsulated biomedical uncertainty. Discussion Even though the perspective that knowledge is socially constructed is not novel in medical education, it is neither universally valued nor universally applied. Moving beyond situativity theories and into broader debates in social sciences provides new opportunities to discuss the nature of scientific knowledge in medical education. We invite a move away from situated learning to situated knowledge

Deploying a clinical innovation in the context of actor-patient consultations in general practice: A prelude to a formal clinical trial

<p>Abstract</p> <p>Background</p> <p>Innovations to be deployed during consultations with patients may influence the clinical performance of the medical practitioner. This study examined the impact on General Practitioners' (GPs) consultation performance of novel computer software, designed for use while consulting the patient.</p> <p>Methods</p> <p>Six GPs were video recorded consulting six actor-patients in a simulated clinical environment. Two sessions were recorded with six consultations per GP. Five cases presented cancer symptoms which warranted a referral for specialist investigation. Practitioners were invited to use a novel software package to process referrals made during the consultations in the second session. Two assessors independently reviewed the consultation performance using the Leicester Assessment Package (LAP). Inter-rater agreement was assessed by a Bland-Altman plot of the difference in score against the average score.</p> <p>Results</p> <p>Sixty of the seventy two consultations were successfully recorded. Each video consultation was scored twice by two assessors leaving 120 LAP scores available for analysis. There was no evidence of a difference in the variance with increasing score (Pitmans test p = 0.09). There was also no difference in the mean differences between assessor scores whether using the software or not (T-test, P = 0.49)</p> <p>Conclusion</p> <p>The actor-patient consultation can be used to test clinical innovations as a prelude to a formal clinical trial. However the logistics of the study may impact on the validity of the results and need careful planning. Ideally innovations should be tested within the context of a laboratory designed for the purpose, incorporating a pool of practitioners whose competencies have been established and assessors who can be blinded to the aims of the study.</p

From respect to reburial: negotiating pagan interest in prehistoric human remains in Britain, through the Avebury consultation

The recent Avebury Consultation on reburial has drawn considerable public and professional attention to the issue of pagan calls for respect towards the care of human remains. Our work has pointed to the importance of archaeologists and others engaging seriously and respectfully with pagans as significant stakeholders in our heritage. The Avebury Reburial Consultation suggests this dialogue is increasing in strength, but we identify problems in the process. We focus here on approaches to the prehistoric dead and worldviews enabling communication from which calls or ‘claims’ for the reburial of prehistoric pagan human remains, versus their retention for scientific study, are articulated; frameworks for assessing and adjudicating such ‘claims’; and implications for the interest groups concerned. We argue that room must be made for philosophical debate and the emotional and spiritual views of pagans, in order to improve dialogue, develop common ground, and enable participatory decision-making and situational pragmatism

Development and face validation of an instrument to assess and improve clinical consultation skills

Context: Development of medical students’ consultation skills with patients is at the core of the UK General Medical Council’s 'Tomorrow’s Doctors' guide (2009). Teaching and assessment of these skills must therefore be a core component of the medical undergraduate curriculum. The Calgary Cambridge guide to the medical interview and the Leicester Assessment Package (LAP) provide a foundation for teaching and assessment, but both have different strengths. Objective: To develop and validate a comprehensive set of generic consultation competencies. Design: The Calgary Cambridge guide to the medical interview was revised to include ‘clinical reasoning’, ‘management’, ‘record keeping’ and ‘case presentation’. Each section was populated with competencies generated from Tomorrow’s Doctors (2009), the LAP and the Calgary Cambridge guide to the medical interview. A Delphi validation study was conducted with a panel drawn from hospital and general practice clinical tutors from eight UK medical schools. Main outcome measures: A priori consensus standards for inclusion (or exclusion) of an element were: at Stage 1 =70% agreement (or disagreement) that the item should be included; at Stage 2 =50% agreement (or disagreement) that the item should be included. If more than 10% of respondents suggested a thematically similar new item (or rewording of an existing item) in Stage 1, it was included in Stage 2. Results: The design stage resulted in a set of 9 categories of consultation skills with 58 component competencies. In the Delphi study all the competencies reached 70% agreement for inclusion, with 24 suggested amendments, all of which achieved consensus for inclusion at Stage 2. Conclusion: We have developed a Generic Consultation Skills assessment framework (GeCoS) through a rigorous initial development and piloting process and a multi-institutional and multi-speciality Delphi process. GeCoS is now ready for use as a tool for teaching, formative and summative assessment in any simulated or workplace environment in the hospital or community clinical setting

Hydrate-phobic surfaces: fundamental studies in clathrate hydrate adhesion reduction

Clathrate hydrate formation and subsequent plugging of deep-sea oil and gas pipelines represent a significant bottleneck for deep-sea oil and gas operations. Current methods for hydrate mitigation are expensive and energy intensive, comprising chemical, thermal, or flow management techniques. In this paper, we present an alternate approach of using functionalized coatings to reduce hydrate adhesion to surfaces, ideally to a low enough level that hydrodynamic shear stresses can detach deposits and prevent plug formation. Systematic and quantitative studies of hydrate adhesion on smooth substrates with varying solid surface energies reveal a linear trend between hydrate adhesion strength and the practical work of adhesion (γ[superscript total][1 + cos θ[subscript rec]]) of a suitable probe liquid, that is, one with similar surface energy properties to those of the hydrate. A reduction in hydrate adhesion strength by more than a factor of four when compared to bare steel is achieved on surfaces characterized by low Lewis acid, Lewis base, and van der Waals contributions to surface free energy such that the practical work of adhesion is minimized. These fundamental studies provide a framework for the development of hydrate-phobic surfaces, and could lead to passive enhancement of flow assurance and prevention of blockages in deep-sea oil and gas operations.Massachusetts Institute of Technology. Energy Initiative (Chevron Corporation)Massachusetts Institute of Technology. Dept. of Mechanical EngineeringNational Research Council (U.S.) (Postdoctoral Fellowship

Droplet mobility on lubricant-impregnated surfaces

Non-wetting surfaces containing micro/nanotextures impregnated with lubricating liquids have recently been shown to exhibit superior non-wetting performance compared to superhydrophobic surfaces that rely on stable air–liquid interfaces. Here we examine the fundamental physico-chemical hydrodynamics that arise when droplets, immiscible with the lubricant, are placed on and allowed to move along these surfaces. We find that these four-phase systems show novel contact line morphology comprising a finite annular ridge of the lubricant pulled above the surface texture and consequently as many as three distinct 3-phase contact lines. We show that these distinct morphologies not only govern the contact line pinning that controls droplets' initial resistance to movement but also the level of viscous dissipation and hence their sliding velocity once the droplets begin to move.United States. Defense Advanced Research Projects Agency. Young Faculty AwardMassachusetts Institute of Technology. Energy InitiativeNational Science Foundation (U.S.). CAREER Award (0952564

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

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 generalpractice makes a major contribution. In this paper we describe the systematic approach wetook to developing the GP curriculum; from the underlying educational principles whichguided its development, the subsequent decisions we made to the curriculum itself. Thisconsists of 23 weeks of clinical placements in general practice; four weeks in year 3, fourweeks in year 4 and 15 weeks in year 5. We describe the steps which were necessary toprepare for the implementation of the GP curriculum.We consider that the successful implementation of our general practice contribution is aresult of our systematic identification of these principles, the clearly articulated designdecisions and the systematic preparation for implementation involving the academic GPteam and all our potential teaching practices

Enhancing authenticity, diagnosticity and equivalence (AD-Equiv) in multicentre OSCE exams in health professionals education: protocol for a complex intervention study

Introduction: Objective structured clinical exams (OSCEs) are a cornerstone of assessing the competence of trainee healthcare professionals, but have been criticised for (1) lacking authenticity, (2) variability in examiners’ judgements which can challenge assessment equivalence and (3) for limited diagnosticity of trainees’ focal strengths and weaknesses. In response, this study aims to investigate whether (1) sharing integrated-task OSCE stations across institutions can increase perceived authenticity, while (2) enhancing assessment equivalence by enabling comparison of the standard of examiners’ judgements between institutions using a novel methodology (video-based score comparison and adjustment (VESCA)) and (3) exploring the potential to develop more diagnostic signals from data on students’ performances. Methods and analysis: The study will use a complex intervention design, developing, implementing and sharing an integrated-task (research) OSCE across four UK medical schools. It will use VESCA to compare examiner scoring differences between groups of examiners and different sites, while studying how, why and for whom the shared OSCE and VESCA operate across participating schools. Quantitative analysis will use Many Facet Rasch Modelling to compare the influence of different examiners groups and sites on students’ scores, while the operation of the two interventions (shared integrated task OSCEs; VESCA) will be studied through the theory-driven method of Realist evaluation. Further exploratory analyses will examine diagnostic performance signals within data. Ethics and dissemination: The study will be extra to usual course requirements and all participation will be voluntary. We will uphold principles of informed consent, the right to withdraw, confidentiality with pseudonymity and strict data security. The study has received ethical approval from Keele University Research Ethics Committee. Findings will be academically published and will contribute to good practice guidance on (1) the use of VESCA and (2) sharing and use of integrated-task OSCE stations

Low-Frequency Observations of the Moon with the Murchison Widefield Array

A new generation of low-frequency radio telescopes is seeking to observe the redshifted 21 cm signal from the epoch of reionization (EoR), requiring innovative methods of calibration and imaging to overcome the difficulties of wide-field low-frequency radio interferometry. Precise calibration will be required to separate the expected small EoR signal from the strong foreground emission at the frequencies of interest between 80 and 300 MHz. The Moon may be useful as a calibration source for detection of the EoR signature, as it should have a smooth and predictable thermal spectrum across the frequency band of interest. Initial observations of the Moon with the Murchison Widefield Array 32 tile prototype show that the Moon does exhibit a similar trend to that expected for a cool thermally emitting body in the observed frequency range, but that the spectrum is corrupted by reflected radio emission from Earth. In particular, there is an abrupt increase in the observed flux density of the Moon within the internationally recognized frequency modulated (FM) radio band. The observations have implications for future low-frequency surveys and EoR detection experiments that will need to take this reflected emission from the Moon into account. The results also allow us to estimate the equivalent isotropic power emitted by the Earth in the FM band and to determine how bright the Earth might appear at meter wavelengths to an observer beyond our own solar system