An evaluation of the reform of the Liverpool Medical Curriculum

Abstract Since the mid 1990s medical education in the UK has undergone fundamental changes, largely in response to the recommendations of the General Medical Council (GMC) in Tomorrow’s Doctors (GMC 1993). In 1996 the University of Liverpool radically altered its undergraduate medical curriculum from a traditional lecture based course to an integrated problem based learning (PBL) curriculum, largely in accordance with the recommendations from the GMC. The primary aim of undergraduate medical education in the UK is to produce competent junior doctors (PRHOs) who meet the standards laid out by the GMC. As the reformed medical curriculum (RMC) has involved such a radical overhaul this dissertation seeks to assess the perceived competencies of Liverpool graduates and gather views on the content of the RMC. The study population comprises PRHOs from the final cohort of the traditional curriculum and the first two cohorts from the RMC and their educational supervisors. Gathering data on the final cohort of the traditional curriculum has allowed comparisons between traditional and RMC graduates. Each PRHO has a named educational supervisor, a consultant or GP for each post they hold during the PRHO year who is formally responsible for monitoring their progress. Three main research tools have been utilised using quantitative and qualitative methodologies. Questionnaires based on the 31 key skills and attitudes PRHOs are meant to learn as undergraduates as listed by the GMC in The New Doctor (1997), were sent to educational supervisors asking them to assess the competencies of the PRHOs they supervise. Each questionnaire has the competencies listed on a 5-point Likert scale ranging from generally not at all competent to generally quite competent with midpoint represented as generally quite competent. The same questionnaires were sent to the PRHOs asking them to assess their own performances. Thirteen Focus groups took place with PRHOs from the study population with the aim of asking them how well prepared they felt they had been to undertake the job of PRHO by the University. They were held towards the end of the PRHO year to allow the PRHOs to reflect on their experiences since graduation and relate them to the medical course. Interviews were arranged with 59 consultants and GPs - around 25% of the educational supervisors in the Mersey area during the summers of 2002 and 2003. The purpose of the interviews was to gain the supervisors’ views on the competencies of the RMC graduates and on the content of the RMC itself. The three-pronged research methodology has allowed triangulation and validation between the different sources giving a fuller picture of the competencies of Liverpool graduates. The results demonstrate that the RMC graduates have been well prepared for the role of PRHO and are actually better prepared than graduates from the traditional curriculum and curriculum reform has largely been welcomed

Graduates from a reformed undergraduate medical curriculum based on Tomorrow's Doctors evaluate the effectiveness of their curriculum 6 years after graduation through interviews

<p>Abstract</p> <p>Background</p> <p>In 1996 Liverpool reformed its medical curriculum from a traditional lecture based course to a curriculum based on the recommendations in Tomorrow's Doctors. A project has been underway since 2000 to evaluate this change. This paper focuses on the views of graduates from that reformed curriculum 6 years after they had graduated.</p> <p>Methods</p> <p>Between 2007 and 2009 45 interviews took place with doctors from the first two cohorts to graduate from the reformed curriculum.</p> <p>Results</p> <p>The interviewees felt like they had been clinically well prepared to work as doctors and in particular had graduated with good clinical and communication skills and had a good knowledge of what the role of doctor entailed. They also felt they had good self directed learning and research skills. They did feel their basic science knowledge level was weaker than traditional graduates and perceived they had to work harder to pass postgraduate exams. Whilst many had enjoyed the curriculum and in particular the clinical skills resource centre and the clinical exposure of the final year including the "shadowing" and A & E attachment they would have liked more "structure" alongside the PBL when learning the basic sciences.</p> <p>Conclusion</p> <p>According to the graduates themselves many of the aims of curriculum reform have been met by the reformed curriculum and they were well prepared clinically to work as doctors. However, further reforms may be needed to give confidence to science knowledge acquisition.</p

Does poor neighbourhood reputation create a neighbourhood effect on employment? The results of a field experiment in the UK

There are substantial variations in labour market outcomes between neighbourhoods. One potential partial explanation is that residents of some neighbourhoods face discrimination from employers. Although studies of deprived areas have recorded resident perceptions of discrimination by employers and negative employer perceptions of certain areas, until now there has been no direct evidence on whether employers treat job applicants differently by area of residence. This paper reports a unique experiment to test for a neighbourhood reputation effect involving 2001 applications to 667 real jobs by fictional candidates nominally resident in neighbourhoods with poor and bland reputations. The experiment found no statistically significant difference in employer treatment of applicants from these areas, indicating that people living in neighbourhoods with poor reputations did not face ‘postcode discrimination’ in the labour market, at the initial selection stage

The challenge of conducting qualitative research to understand the factors that influence equity in medical education: A scoping review

Introduction There are national and international concerns about equity in basic and postgraduate medical education, especially about differential rates of access and attainment across groups of learners. Qualitative research has been increasingly used to understand the factors that influence equity but there are potential limitations to this understanding related to how the research has been conducted. The aim of the scoping review was to identify how qualitative research exploring the factors that influence equity in basic and postgraduate medical education has been conducted. The intention was to inform future research. Methods The electronic databases British Education Index, Campbell Library, CINAHL, Cochrane Library, EMBASE, ERIC, Google Scholar, Health Management Information Consortium (HMIC), MEDLINE, PsycINFO, Web of Science and medical education journals were searched to identify relevant published articles between 2008 and April 2019. Results Among 19,523 articles identified from the literature search, 72 full text articles were included in the review. Most studies had a focus on only one background characteristic and only two studies had a strengths-based focus on individuals. Recommendations for change was at the ‘policy level’ in ten studies and four studies had learner recommendations for change. No studies with a participatory approach were identified. Conclusion The approach to conducting previous qualitative research appears to limit greater understanding of the complexity of factors that influence equity. In response to this challenge, we recommend that future research widen the focus to consider the experiences and strengths of individual learners in addition to those identified by background characteristics. Future qualitative research is recommended to have a broad focus on both the ‘policy level’ and ‘local level’, especially from multiple perspectives. We also recommend greater collaboration of participants with researchers throughout the research process.</p

Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews

<p>Abstract</p> <p>Background</p> <p>In 1996 The University of Liverpool reformed its medical course from a traditional lecture-based course to an integrated PBL curriculum. A project has been underway since 2000 to evaluate this change. Part of this project has involved gathering retrospective views on the relevance of both types of undergraduate education according to graduates. This paper focuses on the views of traditional Liverpool graduates approximately 6 years after graduation.</p> <p>Methods</p> <p>From February 2006 to June 2006 interviews took place with 46 graduates from the last 2 cohorts to graduate from the traditional Liverpool curriculum.</p> <p>Results</p> <p>The graduates were generally happy with their undergraduate education although they did feel there were some flaws in their curriculum. They felt they had picked up good history and examination skills and were content with their exposure to different specialties on clinical attachments. They were also pleased with their basic science teaching as preparation for postgraduate exams, however many complained about the overload and irrelevance of many lectures in the early years of their course, particular in biochemistry. There were many different views about how they integrated this science teaching into understanding disease processes and many didn't feel it was made relevant to them at the time they learned it. Retrospectively, they felt that they hadn't been clinically well prepared for the role of working as junior doctor, particularly the practical aspects of the job nor had enough exposure to research skills. Although there was little communication skills training in their course they didn't feel they would have benefited from this training as they managed to pick up had the required skills on clinical attachments.</p> <p>Conclusion</p> <p>These interviews offer a historical snapshot of the views of graduates from a traditional course before many courses were reformed. There was some conflict in the interviews about the doctors enjoying their undergraduate education but then saying that they didn't feel they received good preparation for working as a junior doctor. Although the graduates were happy with their undergraduate education these interviews do highlight some of the reasons why the traditional curriculum was reformed at Liverpool.</p

Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes:Protocol for a mixed-methods parallel-group randomised feasibility study

BACKGROUND: The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated haemoglobin target-setting. This protocol describes a study to determine the feasibility of evaluating psychological outcomes when setting explicit glycated haemoglobin targets in people with diabetes. METHODS: This single-centre randomised feasibility study will follow a mixed-methods approach across four sub-studies. In sub-study A, eligible adults (aged 18 and over) with type 1 or type 2 diabetes will complete baseline validated psychometric questionnaires evaluating health-related quality of life (EuroQoL-5D-5L), diabetes-related distress (Problem Areas In Diabetes), self-care (Summary of Diabetes Self-Care Activities), well-being (Well-Being Quetionnaire-12) and diabetes-related psychosocial self-efficacy (Diabetes Empowerment Scale-Long Form). Participants will be randomised to receive explicit glycated haemoglobin intervention targets 5mmol/mol above or below current glycated haemoglobin readings. Rates of eligibility, recruitment, retention and questionnaire response rate will be measured. Psychometric outcomes will be re-evaluated 3-months post-intervention. Sub-studies B and C will use qualitative semi-structured interviews to evaluate experiences, views and opinions of diabetes patients and healthcare professionals in relation to the acceptability of study processes, the use of glycated haemoglobin targets, the impact of diabetes on psychological well-being and, in sub-study D, barriers to participation in diabetes research. DISCUSSION: This mixed-methods study aims to provide a novel insight into the psychological implications of glycated haemoglobin target-setting for people with diabetes in secondary care, alongside testing the feasibility of undertaking a larger project of this nature. TRIAL REGISTRATION: The study is registered with the ISRCTN (registration number: 12461724; date registered: 11(th) June 2021). Protocol version: 2.0.5, 26(th) February 2021

An evaluation of the performance in the UK Royal College of Anaesthetists primary examination by UK medical school and gender

<p>Abstract</p> <p>Background</p> <p>There has been comparatively little consideration of the impact that the changes to undergraduate curricula might have on postgraduate academic performance. This study compares the performance of graduates by UK medical school and gender in the Multiple Choice Question (MCQ) section of the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination.</p> <p>Methods</p> <p>Data from each sitting of the MCQ section of the primary FRCA examination from June 1999 to May 2008 were analysed for performance by medical school and gender.</p> <p>Results</p> <p>There were 4983 attempts at the MCQ part of the examination by 3303 graduates from the 19 United Kingdom medical schools. Using the standardised overall mark minus the pass mark graduates from five medical schools performed significantly better than the mean for the group and five schools performed significantly worse than the mean for the group. Males performed significantly better than females in all aspects of the MCQ – physiology, mean difference = 3.0% (95% CI 2.3, 3.7), p < 0.001; pharmacology, mean difference = 1.7% (95% CI 1.0, 2.3), p < 0.001; physics with clinical measurement, mean difference = 3.5% (95% CI 2.8, 4.1), p < 0.001; overall mark, mean difference = 2.7% (95% CI 2.1, 3.3), p < 0.001; and standardised overall mark minus the pass mark, mean difference = 2.5% (95% CI 1.9, 3.1), p < 0.001. Graduates from three medical schools that have undergone the change from Traditional to Problem Based Learning curricula did not show any change in performance in any aspects of the MCQ pre and post curriculum change.</p> <p>Conclusion</p> <p>Graduates from each of the medical schools in the UK do show differences in performance in the MCQ section of the primary FRCA, but significant curriculum change does not lead to deterioration in post graduate examination performance. Whilst females now outnumber males taking the MCQ, they are not performing as well as the males.</p

Quantifying livestock diet compositions in Kenyan smallholder farms

Summary of ongoing PhD research presented as a poster at the University of Edinburgh Global Academy of Agriculture and Food Systems Symposium, 15 March 202