Oral cancer in the UK: to screen or not to screen.

Although oral squamous cell carcinoma accounts for only a small proportion of malignant neoplasms in the UK, oral cancer incidence and mortality rates have been rising in recent years. The natural history of oral cancer is not adequately understood at present and there is very little information about the epidemiology of precancerous lesions in the UK. There are also insufficient data to provide firm evidence that the percentage of cases arising de novo is greater in the UK and the Western world as compared to the Indian subcontinent. Screening for oral cancer by visual examination is simple, inexpensive and causes little discomfort; however, there is no evidence for the effectiveness of screening for oral cancer either in reducing mortality from the disease or in reducing the incidence of invasive disease by detection and treatment of precancerous lesions. There is currently insufficient evidence to recommend population screening for oral cancer in the UK. Measures aimed at primary prevention of the disease may be a more feasible method of disease control at present

Interval cancers in a randomized controlled trial of screening for colorectal cancer using a faecal occult blood test.

BACKGROUND: The sensitivity of unhydrated Haemoccult II has been examined in the context of a randomized controlled trial of faecal occult blood screening for colorectal cancer in Nottingham, UK. METHOD: Both traditional and proportional incidence methods were used to calculate sensitivity separately for both sexes, for two age groups at entry to the trial, for first screen and repeat screens and for three subsites within the large bowel. RESULTS: The traditional method of estimation yielded a sensitivity of 59% whereas the corresponding figure obtained using the proportional incidence method was 54%. The difference between the estimates using the two methods was greatest in subjects aged > or = 65 at entry to the trial and in cancers of the distal colon. CONCLUSIONS: The results suggest that there may be a higher proportion of slower growing tumours in subjects aged > or = 65 and that cancers occurring in the distal colon may have a longer mean sojourn time than cancers proximal to the sigmoid colon

Public Health Education in Medical Schools – The Impact of the COVID-19 Pandemic

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Exploring threshold concepts in population health

Background: Doctors are increasingly expected to improve the health and well-being of populations, as well as to care for individuals. However, despite extensive efforts to integrate population health into undergraduate programmes, engaging students in such learning is notoriously challenging. Threshold concepts are transformative, integrative, irreversible and fundamental to understanding a discipline. Grasping such concepts requires learners to cross a liminal space, which often involves struggle. Methods: We employed a form of transactional curriculum enquiry, involving qualitative and quantitative methods, with experienced population health medical educators to identify and explore threshold and troublesome concepts in population health. Results: Attributing causality, inequalities in health and doctors’ responsibility for populations not just individuals were the concepts most participants thought were threshold. The value of qualitative research, health as politically and socially determined and not taking evidence at face value were the concepts ranked as most troublesome for learners. Participants found the notions of threshold and troublesome concepts helpful and empowering. They described ways these new ideas would influence how they taught population health. Discussion: Transactional curriculum enquiry can offer insights into which population health concepts may be threshold and troublesome. The number of such concepts identified in this study may help explain why students often struggle to engage in population health learning. Understanding which concepts are threshold and particularly which are troublesome can help teachers to better support learners and can also inform curriculum design. If our students are to … take responsibility for populations as well as individuals … it is vital that they cross these fundamental thresholds in learning

A Longitudinal Pathway for Clinical Educators: a Case Study

It is increasingly being recognised that medical education research and scholarship are essential if we are to provide innovative, research-informed teaching to medical students. Developing a discrete pathway for the professional development of clinical educators side by side with clinical training would enable such training to be offered to high caliber candidates. However, the challenges faced by clinical educators trying to deliver both the clinical and educational components of their training to a high standard must not be underestimated. In addition, employing institutions need to consider and agree criteria for career progression of these clinical academics. Identifying a mentor who can guide professional development is crucial, particularly in the early stages

Medical education in the digital age: the role of MOOCs in faculty development

Background In the UK, all postgraduate medical trainees are required to have named, accredited clinical supervisors in every placement from July 2016. Given the time pressures, difficulties of geographical access, and the national drive for professional standards for clinical educators, there is a need to identify appropriate solutions for faculty development. Massive Open Online Courses (MOOCs) have made online learning on a plethora of topics accessible to learners worldwide with several MOOCs suitable for postgraduate medical training offered by USA-based platforms eg. Coursera and EdX; faculty development via MOOCs is negligible. Our 2-week FutureLearn MOOC (March 2015) offers clinical supervision training for faculty development. This study will assess the potential role of MOOCs for faculty development. Summary of work Data will be sourced from course analytics, discussion boards, learner feedback, and educators. The MOOC will be evaluated using a published framework for e-learning in health. Summary of results Course analytics provide a rich source of quantitative and qualitative data (geographic reach, participant roles, motivation to undertake MOOC, etc). Samples of discussion board content will be used to illustrate specific points. Conclusions This work will enable us to assess the role of MOOCs as a vehicle for faculty development. Clinical educators need to maintain and refresh their skills, to maximise patient safety. Could MOOCs provide a potential solution? Take-home message There are significant time and other pressures on busy doctors resulting in a need to identify potential solutions for faculty development. MOOCs have potential to be an efficient solution by enabling learning, sharing and co-constructing knowledge without geographical boundaries. health

“Clinical Supervision with Confidence”: Exploring the potential of MOOCs for faculty development

Background: Postgraduate medical trainees require named clinical supervisors. Given the time pressures and difficulties of geographical access, there is a need to identify appropriate solutions for faculty development. We developed and launched a clinical supervision MOOC (FutureLearn platform) in March 2015. Objective: To assess the potential of the clinical supervision MOOC for faculty development. Methods: Quantitative data was obtained from FutureLearn course analytics and course surveys; qualitative data was obtained from learner feedback within the MOOC. Results: Learners (1,938) from over 75 countries signed up for the MOOC. Of the 899 individuals who began the course, 334 (37.2%) completed. Learners were highly satisfied with the course design and delivery, and enjoyed the opportunities for interprofessional and social learning. Conclusions: MOOCs have great potential for faculty development without geographical boundaries

Supporting motivation in teams working remotely: The role of basic psychological needs

The current disruptive and abrupt transition to remote activities that educational institutions are facing represents a major challenge for the entire academic community. While most concerns have centred on how learning activities may successfully transit from face-to-face to remote delivery, little attention has been given to how educators can be supported in this new unchartered territory. In this article, we discuss the crucial role of team leaders and how their management and leadership style may have great potential to support educators’ motivation. Based on Self-determination Theory, we offer a framework through which team leaders may contribute to create optimal remote working environments for educators. We argue that educators’ autonomous motivation depends on how they perceive their remote work environment as supportive of their basic psychological needs of autonomy, competence and relatedness. Then, we highlight a series of practical recommendations by which team leaders may be more needs-supportive. Working from home requires space, trust, open communication and flexibility, especially considering that team members may have different clinical or personal circumstances. We therefore hope these suggestions are helpful to cultivate educators’ autonomous motivation, which is beneficial not only for themselves but also for others in their institution, including their co-workers and students

Online courses for healthcare professionals: is there a role for social learning?

Background: All UK postgraduate medical trainees receive supervision from trained supervisors. Training has traditionally been delivered via face to face courses, but with increasing time pressures and complex shift patterns, access to these is difficult. To meet this challenge, we developed a two-week massive open online course (MOOC) for faculty development of clinical supervisors. Summary of Work: The MOOC was developed by a group of experienced medical educators and delivered via the FutureLearn (FL) platform which promotes social learning through interaction. This facilitates building of communities of practice, learner interaction and collaboration. We explored learner perceptions of the course, in particular the value of social learning in the context of busy healthcare professionals. We analysed responses to pre- and post-course surveys for each run of the MOOC in 2015, FL course statistics, and learner discussion board comments. Summary of Results: Over 2015, 7,225 learners registered for the course, though 6% left the course without starting. Of the 3,055 learners who began the course, 35% (1073/3055) were social learners who interacted with other participants. Around 31% (960/3055) learners participated fully in the course; this is significantly higher than the FL average of 22%. Survey responses suggest that 68% learners worked full-time, with over 75% accessing the course at home or while commuting, using laptops, smart phones and tablet devices. Discussion: Learners found the course very accessible due to the bite-sized videos, animations, etc which were manageable at the end of a busy working day. Inter-professional discussions and social learning made the learning environment more engaging. Discussion were rated as high quality as they facilitated sharing of narratives and personal reflections, as well as relevant resources. Conclusion: Social learning added value to the course by promoting sharing of resources and improved interaction between learners within the online environment. Take Home Messages: 1) MOOCs can provide faculty development efficiently with a few caveats. 2) Social learning added a new dimension to the online environment

Massive open online courses for continuing professional development of GPs

Continuing professional development (CPD) is essential for the maintenance and improvement of the knowledge and skills of healthcare professionals. GP registrars are required to evidence CPD in their ePortfolio and likewise, GPs are mandated to accrue and evidence a minimum of 50 hours CPD for their annual appraisal. CPD can be delivered in many ways, with an increasing movement towards online learning. Technology-enhanced learning (TEL) encompasses online learning and is ever changing. This article will discuss a type of TEL known as massive open online courses (MOOCs) and the role of MOOCs in delivering CPD