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

From evidence to practice: Developing best practice guidelines for the delivery of activities to people living with moderate to advanced dementia using a pragmatic observational study

The benefits of physical activities for those living with moderate to advanced dementia are well documented and include improved well-being and quality of life. What is less well known is how best to deliver such activities to make them meaningful for those taking part and, more generally, how to develop good practice guidance for working with this group. This article reports on an observational study of a physical activity programme in a residential care setting, Mobile Me, and on the process used to develop good practice guidance from it, which included input from a range of stakeholders. Learnings from this study conclude that changes in delivery and setting can contribute to a difference in the quality of the experience for participants and their levels of well-being during sessions. The findings from the study were consolidated into four themes for disseminating best practice: promoting the right atmosphere, environment, communication, and adaptations. These form part of a new multimedia best practice guide for delivering physical activities to those living with moderate to advanced dementia

A case study of tri-morbidity

Purpose: The purpose of this paper is to highlight the vulnerability of individuals living with tri-morbidity and the complexity of care required to serve this patient group, moreover to consider how a life course approach may assist. Design/methodology/approach: This paper uses a case study of a death of a young male adult experiencing homelessness and tri-morbidity in the UK and comparison of the mortality data for homeless adults in the UK with the general population. A synopsis of the mental health and health inclusion guidance for vulnerable adults is used. Findings: This paper found the importance of considering a life course approach and the impact of negative life events on individuals living with tri-morbidity and also the role of specialist services to support the complex needs of vulnerable adults including the importance of multi-disciplinary working and holistic care. Research limitations/implications: The research implications of this study are to consider how individuals living with tri-morbidity fit in to evidence-based care. Practical implications: The practical implication is to consider that those living with tri-morbidity have extra-ordinary lives often with a high concentration of negative life events. Therefore, an extra-ordinary approach to care maybe needed to ensure health inequalities are reduced. Social implications: This paper is an important case highlighting health inequalities, specifically mortality, in the homeless population. Originality/value: This paper is an original piece of work, with real cases discussed but anonymised according to guidance on reporting death case reports

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

The role of karmic beliefs in immanent justice reasoning

Karmic belief—the expectation that actions bring about morally congruent outcomes within and across lifetimes—is central to many, particularly Eastern, religions. This research (N = 704) examined whether karmic beliefs and cultural context (predominantly Christian Americans and Hindu Indians) moderated the indirect effect of learning about others’ morally congruent or incongruent negative outcomes on immanent justice reasoning (causally attributing misfortune to someone’s prior misdeeds) through perceived deservingness. Results revealed that the indirect effect of congruency on immanent justice attributions via deservingness was stronger for people higher in karmic beliefs, because they strengthened the effect of congruency on immanent justice attributions and the relationship between deservingness and immanent justice attributions. The indirect effect of congruency on immanent justice attributions through deservingness was also stronger in the United States. These results highlight the role that karmic beliefs play in how people reason about the causes of others’ fortunes and misfortunes

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

Evaluating a specialist primary care service for patients experiencing homelessness:A qualitative study

Background: People experiencing homelessness (PEH) often experience poor health, multimorbidity, and early mortality and experience barriers to accessing high quality health care. Little is known about how best to provide specialist primary care for these patients. Aim: To evaluate the health care provided to patients experiencing homelessness who were seen in a specialist primary care service. Design & setting: A qualitative evaluation of a city centre primary healthcare service for excluded and vulnerable people, such as rough sleepers, who find it difficult to visit mainstream GP services. Method: Data on patient characteristics and service use were extracted from primary care records using electronic and free-text searches to provide context to the evaluation. Semi-structured interviews with 11 patients and four staff were used to explore attitudes and experiences. Results: Patients had high needs compared with the general population. Patients valued continuity of care, ease of access, multidisciplinary care, and person-centred care. Staff were concerned that they lacked opportunities for reflection and learning, and that low clinical capacity affected service safety and quality. Staff also wanted more patient involvement in service planning. Conclusion: PEH's complex health and social problems benefited from a specialist primary care service, which is thought to reduce barriers to access, treat potentially challenging patients in a nonjudgmental way, and provide personal continuity of care in order to develop trust

A report on the experience of people in receipt of fuel and food vouchers from Norwich Foodbank: A qualitative study

Background: For people on very low incomes, both household fuel and food environments are becoming more uncertain. Many households are in precarious situations, having little control over their lives, including making constant trade-offs between heating and eating. In addition to providing emergency food parcels, Norwich Foodbank also supplies emergency fuel payments. Recently they have seen a major uplift in the need for these. As this is a relatively new service, they need to better understand how people are using the service, and how they might improve what they offer. The brief: The aim of this small qualitative study was to provide independent insights into the experiences of people using fuel and food vouchers at Norwich Foodbank. What we did: We interviewed six people who had been in receipt of fuel and food vouchers between May and November 2022. Main findings: The context of all our interviews were the feelings of overwhelming uncertainty that they experienced. Within this, we identified six key themes from the analysis of our interviews: Accessing the service; Shame; Experience of being a user of the service; Seeking help from other services; Planning and trade-offs and Missing out Suggestions: We identified four recommendations. Firstly, around access to the service, especially for first time users who are in state of denial and shock when they first recognise their need for help with food and fuel. They find it difficult to navigate the system and because they feel guilty about needing to use the service, they don’t like to ask what else they could be entitled to, or what other services are available. Greater clarity in this information would be helpful. Secondly, all our interviews had had acute and complex needs that would have benefited from additional advice. Norwich Foodbank is ideally placed to provide additional support or social prescribing to meet people’s needs in a holistic way. There was a recognition that people were at ‘rock bottom’ before they sought help and that a food parcel or fuel voucher was only a temporary respite and that a follow-up phone call to check up on them and their needs could be really helpful. Finally, advice around cooking with slow cookers and the ingredients in the food parcel and energy saving advice, as people are currently doing this via Google but would appreciate it coming directly from a trustworthy source

Goal-setting with patients with multi-morbidity. Finding a way to achieve ‘what really matters’

It can be a challenging task for GPs to find the best approach to providing care for patients with multiple medical conditions (multi-morbidity). Most care focuses on the management of single diseases; however, adopting a patient-centred focus may be better for patients with multi-morbidity. This is encouraged in recent health policy and guidance. However, it is not always clear how this should be put into practice. This article describes how GPs might use ‘goal-setting’ during consultations with patients with multi-morbidity, to help achieve more effective care that is better suited to patient’s needs

Humanising medicine: teaching on tri-morbidity using expert patient narratives in medical education

Expert patients have recognised benefits for both students and patients in medical education. However, marginalised patients such as homeless patients are less likely to participate. Learning from such individuals is crucial for future doctors, who can, in turn, aid their inclusion in society and improve access to health care. A 'humanising medicine' lecture was delivered to Year Four medical students at Norwich Medical School. The lecture utilised narratives from patients with experience of homelessness and tri-morbidity (physical and mental health problems and substance abuse). We used a qualitative approach to evaluate this teaching and understand the experience of both students and patients. Students were asked to complete questionnaires, whereas expert patients were interviewed. We thematically analysed data using an inductive approach. Students reported an increased understanding, empathy and preparedness to consult with marginalised patients. Expert patients described positive feelings about their involvement, giving something back, and the therapeutic benefits of telling their story. We found that including marginalised patients in medical education had positive benefits for both students and patients. Our findings suggest that expert patient narratives are valuable in medical education particularly in teaching and learning about medical complexity and tri-morbidity