The learning and teaching of cultural diversity in undergraduate medical education in the UK.

The aim of this thesis is to identify and analyse the origins, organisation, contents, delivery and outcomes of the learning and teaching of 'cultural diversity' within undergraduate medical education in the UK. Literature reviews of the history of medical education and relevant educational theory were conducted. Two ideal type models of 'cultural diversity' teaching programmes, designated as the 'cultural expertise' model and the 'cultural sensibility' model, were devised. Comparisons were made between the educational philosophy, educational process, educational content and outcomes of the two models. The models were then utilised as benchmarks against which to analyse and compare approaches and programmes to the teaching of 'cultural diversity'. The main research objective was to identify perceptions and evaluations of the teaching and learning of 'cultural diversity' held by a range of stakeholders in medical education including policymakers, school heads, teaching staff, researchers, students and users. Qualitative interviews of 61 respondents and documentary analysis were undertaken. The key findings are that the origins of 'cultural diversity' education have been driven more by political than educational agendas. As a result, the development of 'cultural diversity' teaching has not been systematic and has been inadequately informed by available theory or evidence. Programmes have evolved through the advocacy of individuals, many of who have not been involved in the development of education strategy. Contents and assessment processes are driven largely by ideas that are consistent with the 'cultural expertise' ideal type but the desired outcomes in clinical practice and for students are more in line with the 'cultural sensibility' model. Ambivalence towards assessment in this area, and the management of students who demonstrate inappropriate attitudes needs resolution since the current position undermines the development of the subject. Specific recommendations for each stakeholder group are included and the thesis concludes with ideas for future research

Stakeholder views regarding cultural diversity teaching outcomes: a qualitative study

Background: Cultural diversity teaching is increasingly present in both undergraduate and postgraduate training programmes. This study explored the views of stakeholders in medical education about the potential outcomes of cultural diversity teaching and how they thought cultural diversity programmes might be effectively evaluated. Methods: A semi-structured interview was undertaken with 61 stakeholders (including policymakers, diversity teachers, students and users). The data were analysed and themes identified. Results: Many participants felt that clinical practice was improved through 'cultural diversity teaching' and this was mostly as a result of improved doctor-patient communication. There was a strong view that service users need to participate in the evaluation of outcomes of cultural diversity teaching. Conclusion: There is a general perception, rather than clear evidence, that cultural diversity teaching can have a positive effect on clinical practice. Cultural diversity teaching needs to be reviewed in undergraduate and postgraduate medicine and better evaluation tools need to be established

A survey of the practice and experience of clinical educators in UK secondary care

Background: Experiences and attitudes of clinical trainers of undergraduate medical students and postgraduate medical trainees in secondary care have received limited attention. Anecdotally, clinical teaching is becoming increasingly restricted by clinical service pressures, thereby presenting a risk to the quality of training provision. Methods: To explore the commitment, experience and attitudes of clinical teachers and trainers of undergraduate medical students and postgraduate trainees, respectively, amongst secondary care providers across a UK Healthcare Workforce Deanery, an invitation to complete a study-specific, on-line survey, comprising predominantly yes/no response and 5-point Likert scale statements with some open questions, was sent to all registered secondary care trainers/supervisors working in the East Midlands Strategic Health Authority. The survey was open between February and June 2012, with two reminders to complete. Responses were anonymised and the frequency of responses to questions was analysed. Data were analysed for the whole study population and for the relationship between frequency of responses and gender. Results: The majority of teachers/trainers considered that they were well prepared and fulfilled their clinical teaching responsibilities. Many reported having restricted time for preparation and delivery and that teaching activities were often completed in their own time. Despite reported poor support and low incentives, many respondents felt valued for their clinical teaching by their Medical Schools and the Deanery, but less so by hospital Trusts. Conclusions: Respondents indicated that some faculty like and enjoy clinical teaching despite lack of allocated time, resources and recognition. The majority indicated that they feel confident and competent in their clinical teaching roles. Insufficient dedicated time due to competing clinical service pressures was reported as the major barrier to clinical teaching provision

Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

BACKGROUND: Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. METHOD: The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. RESULTS: An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. CONCLUSIONS: No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area

Additional file 1: of Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

Interview guide – Stakeholder interviews (all groups) – Qualitative interview data. (DOCX 22 kb

The Foundation Programme in psychiatry: a qualitative study into the effects of a foundation placement

Aims and method There is a drive to increase the number of psychiatry foundation placements to ensure that training keeps up with the changing health and social care landscape. This qualitative study aimed to explore, by interview, the experiences of 17 doctors who have completed a foundation placement in psychiatry. Results The study highlights the benefits of foundation psychiatry placements and some of their positive and negative aspects. Clinical implications Those developing foundation placements will need to ensure they are of high quality. Declaration of interest None

Culturally competent in medical education – european medical teachers’ self-reported preparedness and training needs to teach cultural competence topics and to teach a diverse class

Background: Health inequalities related to culture and ethnicity may be reduced by training future health care providers. Medical teachers therefore also need to be culturally competent. The aim of this study was to assess medical teachers’ preparedness and their training needs to teach cultural competence topics and to teach a diverse class. Methods:A link to an online survey was sent to medical teachers of eleven European institutions. Results were analysed through descriptive analysis and answers to open-ended questions were analysed using qualitative analysis. Results:968 respondents were included. The majority of respondents felt it was important that cultural competence topics should be incorporated into the medical curriculum. Assessment of skills in cultural competence was found important as well

Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents

Despite growing evidence of the effects of social media on the mental health of adolescents, there is still a dearth of empirical research into how adolescents themselves perceive social media, especially as knowledge resource or how they draw upon the wider social and media discourses to express a viewpoint. Accordingly, this paper contributes to this scarce literature. Six focus groups took place over three months with 54 adolescents aged 11–18 years, recruited from schools in Leicester and London (UK). Thematic analysis suggested that adolescents perceived social media as a threat to mental wellbeing and three themes were identified; 1) it was believed to cause mood and anxiety disorders for some adolescents, (2) it was viewed as a platform for cyberbullying, and (3) the use of social media itself was often framed as a kind of ‘addiction’. Future research should focus on targeting and utilising social media for promoting mental wellbeing among adolescents and educating youth to manage the possible deleterious effects

Exploring the potentially positive interaction between social media and mental health; the perspectives of adolescents

Adolescents are spending significant time online. Consequently, concerns are consistently raised about potential negative impacts on their mental health. Potentially, these concerns minimise their autonomy and reify the construction of the vulnerable adolescent. Using template analysis, we explored adolescents’ perspectives (N = 54) of the relationship between social media and mental health. We centrally considered the wide array of uses made of different social media by the participants, focusing on their understandings of the potentially positive effects these might have. Focus group discussions showed social media could be used to reduce stress, have value for social connectivity, were an important source of information about mental health, and provided a platform for peer-to-peer support. Our conclusion indicated adolescents are generally socially competent online and are often experimenting with their emergent sense of agency

Whose responsibility is adolescent mental health in the UK? Perspectives of key stakeholders

The mental health of adolescents is a salient contemporary issue attracting the attention of policy makers in the UK and other countries. It is important that the roles and responsibilities of agencies are clearly established, particularly those positioned at the forefront of implementing change. Arguably, this will be more effective if those agencies are actively engaged in the development of relevant policy. An exploratory study was conducted with 10 focus groups including 54 adolescents, 8 mental health practitioners and 16 educational professionals. Thematic analysis revealed four themes: 1) mental health promotion and prevention is not perceived to be a primary role of a teacher; 2) teachers have limited skills to manage complex mental health difficulties; 3) adolescents rely on teachers for mental health support and education about mental health; and 4) child mental health responsibility extends to parents. The research endorses the perspective that teachers can support and begin to tackle mental wellbeing in adolescents. However, it also recognises that mental health difficulties can be complex, requiring adequate funding and support beyond school. Without this support in place, teachers are vulnerable and can feel unsupported, lacking in skills and resources which in turn may present a threat to their own mental wellbeing