Legal aspects in nurse prescribing

This article discusses the legal implications nurse prescribers need to be aware of in their interactions with patients. There have been huge changes as a result of common law changes regarding consent and autonomy

Toward interprofessional learning and education:Mapping common outcomes for prequalifying healthcare professional programs in the United Kingdom

Introduction: Interprofessional education (IPE) continues to be a key component in prequalifying health professional education, with calls for regulators to publish a joint statement regarding IPE outcomes. To date, the regulatory documents for healthcare education in the United Kingdom have not been examined for common learning outcomes; information that could be used to inform such a statement and to identify opportunities for interprofessional learning. Methods: A mapping of the outcomes/standards required by five, UK, health profession regulatory bodies was undertaken. This involved the identification of common outcomes, a keyword search and classification of common outcomes/standards; presented as themes and subthemes. Results: Seven themes were identified: knowledge for practice, skills for practice, ethical approach, professionalism, continuing professional development (CPD), patient-centered approach and teamworking skills, representing 22 subthemes. Each subtheme links back to the outcomes/standards in the regulatory documents. Conclusions: This study identifies the key areas of overlap in outcomes/standards expected of selected healthcare graduates in the United Kingdom. The mapping provides a framework for informing prequalifying IPE curricula, for example, identifying possible foci for interprofessional education outcomes and associated learning opportunities. It allows reference back to the standards set by regulatory bodies, a requirement for all institutions involved in health profession education

How medical students demonstrate their professionalism when reflecting on experience

Objectives:  This paper aims to examine the discourses used by students in a formal assessment of their ability to demonstrate professional values when reflecting on their experiences. Methods:  We carried out a discourse analysis of 50 randomly selected essays from a summative assessment undertaken by all five year groups of students in one UK medical school. Results:  Students were able to identify a wealth of relevant examples and to articulate key principles of professional practice. They were also able to critique behaviours and draw appropriate conclusions for their own intended professional development. Detailed textual analysis provided linguistic clues to the depth of apparent reflection: recurrent use of rhetorical language with minimal use of first-person reflections, lack of analysis of underlying factors, and simplistic views of solutions may all indicate students whose ability to learn by reflection on experience needs further development. There were also areas in which cohorts as a whole appeared to have a limited grasp of the important professional issues being addressed. Conclusions:  Assessing written reflections is a useful way of making students link their experiences with professional development. The detailed analysis of language usage may help to refine marking criteria, and to detect students and course components where reflective learning competencies are not being achieved

Unexpected medical undergraduate simulation training (UMUST): can unexpected medical simulation scenarios help prepare medical students for the transition to foundation year doctor?

BACKGROUND: Preparing medical students with the skills necessary to deal with emergency situations as junior doctors can be challenging due to the complexities of creating authentic ‘real life’ experiences in artificial environments. The following paper is an evaluation of the UMUST (Unexpected Medical Undergraduate Simulation Training) project; a high-fidelity simulation based training programme designed to emulate the experience of dealing with medical emergencies for final year medical students preparing for practice as Foundation Year trainees. METHODS: Final year medical students from Liverpool University who undertake their clinical placements at Blackpool Teaching Hospitals NHS Foundation Trust and St. Helens & Knowsley Teaching Hospitals NHS Trust were randomly allocated into groups and took part in a series of four unexpected simulation based scenarios. At the beginning of the week in which the scenarios ran, participants were issued with a hospital bleep which they carried with them during their placement. At an unknown time to them, the participants were bleeped to attend a simulated emergency scenario, and on arrival to the Clinical Skills and Simulation facility, members of the education team undertook a standardised simulation scenario. Each session was recorded on video which the participants subsequently watched as part of a debriefing process. An assessment tool was developed to gauge whether the participants made progress in their learning over the course of the four sessions. Focus groups were held with the participants in order to evaluate their experience of the programme, and questionnaires were later distributed to all participants once they had begun working as a Foundation Year trainee. The questionnaires asked them how relevant UMUST was in preparing them for dealing with medical emergencies. RESULTS: The questionnaires and the focus groups clearly showed that the doctors felt like UMUST was very valuable in preparing them to work as junior doctors. They had enjoyed taking part in UMUST and thought was a realistic and useful part of their undergraduate training. CONCLUSIONS: The feedback from the focus groups and the subsequent questionnaires clearly demonstrate that participants felt the UMUST programme helped to prepare them as junior doctors in terms of dealing with emergency situations

On being an expert witness in sexual and reproductive health.

A new generation of expert witnesses in sexual and reproductive health is needed, including those in nursing as well as medical roles. Being an expert witness is a significant commitment alongside clinical work. Nevertheless, the work is stimulating and rewarding. Training is essential before starting medicolegal work. In particular expert witnesses need to be able to apply appropriate legal tests to the evidence, to deal with the range of expert opinion on a matter, and explain clearly what constitutes an appropriate standard of care for a clinician in their discipline and specialty. Expert witnesses must be aware of pitfalls such as being sued for substandard work and being reported to their professional regulator for straying outside their area of expertise. Expert witnesses must be truly independent and ideally their reports should be the same whoever they receive their instructions from. In addition to report writing, expert witnesses are required to comment on court documents, participate in conferences with a barrister and hold formal discussions with an opposing expert witness. Expert witnesses need to be administratively efficient and responsive. Although appearance in court is not that common, this is an essential part of the role. Apart from litigation in the civil courts, other types of case may present themselves including patent cases, work in the Court of Protection and health professionals' Fitness to Practise hearings

Changes in standard of candidates taking the MRCP(UK) Part 1 examination, 1985 to 2002: Analysis of marker questions

The maintenance of standards is a problem for postgraduate medical examinations, particularly if they use norm-referencing as the sole method of standard setting. In each of its diets, the MRCP(UK) Part 1 Examination includes a number of marker questions, which are unchanged from their use in a previous diet. This paper describes two complementary studies of marker questions for 52 diets of the MRCP(UK) Part 1 Examination over the years 1985 to 2001 to assess whether standards have changed

Introducing quality improvement teaching into general practice undergraduate placements

Quality Improvement skills are deemed essential for future clinical practice of doctors by professional regulatory bodies. This paper presents the challenges of a curriculum development initiative to ensure that all medical students have involvement with a quality improvement project during a general practice placement in their fourth year. The curriculum development is described within a 'Plan-Do-Study-Act' framework. The learning is presented as a reflective discussion with conclusions and recommendations on how potential current barriers to implementing authentic participation in quality improvement projects for undergraduate medical students might be met. The key barriers include lack of opportunities within the curriculum structure to allow sufficient time for authentic quality improvement projects and a lack of confidence amongst placement tutors to support medical students with quality improvement projects

Purposeful involvement of experts by experience

BACKGROUND: There is a growing requirement from professional bodies in the UK that health and social care education must include the voice of experts by experience (EbE). Active steps have been taken at the international level in order to truly embed their involvement. In parallel with this development, there is compounding evidence collated globally that links interprofessional education (IPE) to improved health outcomes. As the involvement of EbE plays a central role in IPE there is an increased expectation for teachers to be able to successfully involve EbE in IPE and other health education. ISSUE: Although there is some guidance available to teachers on how to involve EbE in pre-registration health and social care education, less guidance is available on how to involve EbE in complex educational interventions, such as IPE. Hence the need for faculty member development. APPROACH: The Centre for Interprofessional Practice (CIPP) has involved nearly 350 EbE in a variety of IPE since 2005. This review draws on insights from the CIPP to identify a number of practice points for teachers who wish to involve EbE in IPE, or as part of education for their specific profession. The practice points are endorsed by EbE and discussed in light of initiatives and evidence reported by others in the literature. To help contextualise and make use of these practice points they were grouped according to the presage-process-product (3P) model. This article can inform faculty member development aimed at new or senior educators, and our insights are equally applicable to both uni- and interprofessional contexts

Supporting international graduates to success

Since 2012, researchers and clinicians in one National Health Service (NHS) Trust have been involved in an NHS led and funded project to develop and evaluate a programme to support International Medical Graduates; (IMGs; graduates who have obtained their medical degree outside the country in which they work). The synthesis of this work is presented here as a toolbox, providing an evidence- guided example of best practice for supporting IMGs