STEM Careers Awareness Timelines Attitudes and ambitions towards science, technology, engineering and maths (STEM at Key Stage 3)

The importance of science, technology, engineering and maths (STEM) expertise to the UK economy is generally accepted as key to maintaining our international competitiveness. This importance was noted in the 2002 review by Sir Gareth Roberts, ‘Set for Success: The supply of people with science, technology, engineering and mathematics skills’. This report stemmed from the, ‘Government’s concern that the supply of high-quality scientists and engineers should not constrain the UK’s future research and development (R&D) and innovation performance.’ (Roberts, 2002, p.1

STEM Careers Awareness Timelines

The importance of science, technology, engineering and maths (STEM) expertise to the UK economy is generally accepted as key to maintaining our international competitiveness. This importance was noted in the 2002 review by Sir Gareth Roberts, ‘Set for Success: The supply of people with science, technology, engineering and mathematics skills’. This report stemmed from the, ‘Government’s concern that the supply of high-quality scientists and engineers should not constrain the UK’s future research and development (R&D) and innovation performance.’ (Roberts, 2002, p.1) ‘A shortage of graduates in these disciplines is likely to become increasingly serious since the UK economy – with its large financial services sector, strong science base and increasing focus on high-tech and high value-added manufacturing businesses – is likely to need more mathematics and physical science graduates, not fewer’ (Roberts, 2002, p. 49). The report highlighted increasing employer difficulties in the recruitment of suitably qualified scientists and engineers, and corresponding implications for future UK competitiveness. Although recruitment data revealed that employers and universities were not doing enough to attract candidates by offering competitive conditions of employment, the report highlighted ‘poor experiences of science and engineering education among pupils generally, coupled with a negative image of, and inadequate information about careers arising from the study of science and engineering.’ Addressing these issues would require, ‘Action in schools and further and higher education’ (Roberts, 2002, p.3). Recent years have thus seen much emphasis placed on the quality of learning and teaching of STEM subjects in schools, accompanied by adequate IAG provision. However, STEM subjects are being dropped at school by young people in favour of other choices prior to, and following GCSEs, with worrying implications for higher level STEM study, and subsequently careers such as engineering, construction and scientific research. Consequently, the Department for Children, Schools and Families (DCSF) have developed a suite of 11 Action Programmes within a strategic framework to prioritise STEM issues. Action Programme 8 focussed on careers and seeks to achieve two objectives: • For all young people to be made aware of the fulfilling and attractive careers open to them through the continued study of science and mathematics • To provide the knowledge and skills to enable young people to make informed subject choices to achieve qualifications to keep their options open for further study and careers in STEM

A typology of longitudinal integrated clerkships

Context Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time‐limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution‐specific studies. Objectives This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. Methods Data on all LIC and LIC‐like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student‐years of LIC‐like curricula. Results Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC‐like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. Conclusions Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context

Hunting for answers: Linking lectures with the real world using a mobile treasure hunt app

Plants underpin our society providing food, fuel, medicines, clean air and water, positive mental health, and are central to biodiversity conservation. Despite this importance and an increasing need for people with plant-identification skills, many societies are becoming increasingly ignorant to the species with which they interact. To benefit both our undergraduates and the society they will enter, we applied mobile technology to improve plant identification and appreciation , while providing opportunities to practice transferable team work and verbal communication skills. Encouraging 'plant vision' will improve conservation efforts while increasing personal connections with green spaces, leading to mental health improvements for society. Summary • Despite the importance of plants to human civilization, many societies are becoming increasingly ignorant to the plants that inhabit their surrounding environment. A phenomenon known as 'plant blindness'. To address plant blindness in undergraduate students we designed an outdoor activity using a mobile phone app. Our aims were to identify the level of 'plant blindness' in our students; investigate engagement with the app and activity ; determine if we can raise awareness of links between lecture content and real world scenarios; and assess the student experience as a result of the activity in large classes. • The app chosen was ActionBound. Students were asked to find and photograph local examples of four plant families, along with identifying physiological benefits of features covered in lectures. Two different first year classes were exposed to this activity-Plant Science and Life on Earth. • The Plant Science students (60% success rate for three families; 55 students) were less plant blind than Life on Earth students (less than 44% success rate in any of the four families; 200 students). Students engaged well with the activity with all groups submitting sensible attempts at the responses. Most students reported that the activity increased links to lecture material and all but one student reported positive experiences. • Our students found the treasure hunt learning environment is a fun way to engage with the plant topics covered in lectures. In future iterations, we will more explicitly explain the links to potential careers and will address some of the logistical challenges faced in this first cohort. K E Y W O R D S collaborative learning, fun learning, inclusivity, large classes, mobile learning, plant blindness, situational learning, treasure hun

Perceptually relevant remapping of human somatotopy in 24 hours

Experience-dependent reorganisation of functional maps in the cerebral cortex is well described in the primary sensory cortices. However, there is relatively little evidence for such cortical reorganisation over the short-term. Using human somatosensory cortex as a model, we investigated the effects of a 24 hr gluing manipulation in which the right index and right middle fingers (digits 2 and 3) were adjoined with surgical glue. Somatotopic representations, assessed with two 7 tesla fMRI protocols, revealed rapid off-target reorganisation in the non-manipulated fingers following gluing, with the representation of the ring finger (digit 4) shifted towards the little finger (digit 5) and away from the middle finger (digit 3). These shifts were also evident in two behavioural tasks conducted in an independent cohort, showing reduced sensitivity for discriminating the temporal order of stimuli to the ring and little fingers, and increased substitution errors across this pair on a speeded reaction time task

Are medical students influenced by preceptors in making career choices, and if so how? A systematic review

A B S T R A C T Introduction: Increasingly medical students undertake clinical training in distributed learning environments. The driving factor for this is predominantly to address medical workforce shortages. In these environments students are often taught by private practitioners, residents, house staff and registrars, as well as faculty. Through a mix of short-and long-term preceptorships, clerkships and rotations, medical students are exposed to a wider range of preceptors, mentors and role models than has traditionally been the case. The aim of this systematic review was to understand if and how medical students' career choices are influenced by their interactions with preceptors. Method: A search of Ovid Medline, Scopus, ISI Web of Science, PubMed, Eric and CIHNAL was undertaken. The search was structured around the key terms: Medical Student, Career Choice and Preceptor, and variants of these terms. Search limits were set to English-language publications between 1995 and 2010. Results: A total of 36 articles met the selection criteria from the 533 citations sourced from the search. Required preceptorships as short as 3 weeks' duration influence the career choice of students when they rate the preceptor as a high quality teacher. Preceptors who are judged (by students) as high quality teachers have the greatest influence on student career choice by up to four-fold. When students judged a preceptor as being a negative role model, a poor teacher or lacking discipline specific knowledge they will turn away from that field. The positive influence of relationships between preceptors and students on career choice is strongest where Sweet, 2012. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 there is continuity of preceptors, continuity of care, and continuity of patient interactions. The longer the duration of the preceptorship the greater the influence on student career choice, particularly in primary cares environments. Conclusion: This review adds to the literature by identifying how differing components and combinations of components of a preceptorship influence medical student career choices. Multiple components of the preceptorship combined have a greater influence. In free choice, longitudinal integrated clerkships' duration of placement and continuity relationships with preceptors have the greatest influence on medical students in pursuing a primary care career. This information informs medical schools, curriculum designers and policy-makers in reforming medical education to address workforce shortages

Temporal Factors and Missed Doses of Tuberculosis Treatment: A Causal Associations Approach to Analyses of Digital Adherence Data

Rationale: Tuberculosis treatment lasts for 6 months or more. Treatment adherence is critical; regimen length, among other factors, makes this challenging. Globally, analyses mapping common types of nonadherence are lacking. For example, is there a greater challenge resulting from early treatment cessation (discontinuation) or intermittent missed doses (suboptimal dosing implementation)? This is essential knowledge for the development of effective interventions and more "forgiving" regimens, as well as to direct national tuberculosis programs.Objectives: To granularly describe how patients take their tuberculosis medication and the temporal factors associated with missed doses.Methods: The present study included patients with pulmonary tuberculosis enrolled in the control arm of a pragmatic, cluster-randomized trial in China of electronic reminders to improve treatment adherence. Treatment was the standard 6-month course (180 d), dosed every other day (90 doses). Medication monitor boxes recorded adherence (box opening) without prompting reminders. Patterns of adherence were visualized and described. Mixed-effects logistic regression models examined the temporal factors associated with per-dose suboptimal dosing implementation, adjusting for clustering within a participant. Cox regression models were used to examine the association between early suboptimal dosing implementation and permanent discontinuation.Results: Across 780 patients, 16,794 (23.9%) of 70,200 doses were missed, 9,487 of which were from suboptimal dosing implementation (56.5%). By 60 days, 5.1% of participants had discontinued, and 14.4% had discontinued by 120 days. Most participants (95.9%) missed at least one dose. The majority of gaps were of a single dose (71.4%), although 22.6% of participants had at least one gap of 2 weeks or more. In adjusted models, the initiation-continuation phase transition (odds ratio, 3.07 [95% confidence interval, 2.68-3.51]) and national holidays (1.52 [1.39-1.65]) were associated with increased odds of suboptimal dosing implementation. Early-stage suboptimal dosing implementation was associated with increased discontinuation rates.Conclusions: Digital tools provide an unprecedented step change in describing and addressing nonadherence. In our setting, nonadherence was common; patients displayed a complex range of patterns. Dividing nonadherence into suboptimal dosing implementation and discontinuation, we found that both increased over time. Discontinuation was associated with early suboptimal dosing implementation. These apparent causal associations between temporal factors and nonadherence present opportunities for targeted interventions.Clinical trial registered with the ISRCTN Registry (ISRCTN46846388)

Universal HIV testing in London tuberculosis clinics: a cluster randomised controlled trial

We assessed whether implementation of a combination of interventions in London tuberculosis clinics raised the levels of HIV test offers, acceptance and coverage. A stepped-wedge cluster randomised controlled trial was conducted across 24 clinics. Interventions were training of clinical staff and provision of tailor-made information resources with or without a change in clinic policy from selective to universal HIV testing. The primary outcome was HIV test acceptance amongst those offered a test, before and after the intervention; the secondary outcome was an offer of HIV testing. Additionally, the number and proportion of HIV tests among all clinic attendees (coverage) was assessed. 1,315 patients were seen in 24 clinics. The offer and coverage of testing rose significantly in clinics without (p = 0.002 and p = 0.004, respectively) and with an existing policy of universal testing (p = 0.02 and p = 0.04, respectively). However, the level of HIV test acceptance did not increase in 18 clinics without routine universal testing (p = 0.76) or the six clinics with existing universal testing (p = 0.40). The intervention significantly increased the number of HIV tests offered and proportion of participants tested, although acceptance did not change significantly. However, the magnitude of increase is modest due to the high baseline coverage

All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era

Adherence to treatment for tuberculosis (TB) has been a concern for many decades, resulting in the World Health Organization's recommendation of the direct observation of treatment in the 1990s. Recent advances in digital adherence technologies (DATs) have renewed discussion on how to best address nonadherence, as well as offering important information on dose-by-dose adherence patterns and their variability between countries and settings. Previous studies have largely focussed on percentage thresholds to delineate sufficient adherence, but this is misleading and limited, given the complex and dynamic nature of adherence over the treatment course. Instead, we apply a standardised taxonomy – as adopted by the international adherence community – to dose-by-dose medication-taking data, which divides missed doses into 1) late/noninitiation (starting treatment later than expected/not starting), 2) discontinuation (ending treatment early), and 3) suboptimal implementation (intermittent missed doses). Using this taxonomy, we can consider the implications of different forms of nonadherence for intervention and regimen design. For example, can treatment regimens be adapted to increase the “forgiveness” of common patterns of suboptimal implementation to protect against treatment failure and the development of drug resistance? Is it reasonable to treat all missed doses of treatment as equally problematic and equally common when deploying DATs? Can DAT data be used to indicate the patients that need enhanced levels of support during their treatment course? Critically, we pinpoint key areas where knowledge regarding treatment adherence is sparse and impeding scientific progress