Incorporating the interaction between health and work into the undergraduate medical curriculum – a qualitative evaluation of a teaching pilot in English medical schools

Introduction: There is a growing recognition of the impact of work on health both positive and negative. It is important that all health care professionals are equipped to understand the effects of work and worklessness on health and help patients remain in work or manage a healthy return to work where appropriate. Despite explicit reference to health and work in the General Medical Council’s Outcomes for Graduates, currently, there is not a theme that is integrated across the undergraduate medical curricula. Aim: This study evaluates medical tutors’ and undergraduates’ perspectives of a selection of health and work topics in a teaching pilot to consider the suitability and appropriateness for delivery, integration into the curriculum, tailoring of the resources, and appropriateness and expected attainment of learning objectives. Methods: Qualitative, semi structured interviews and focus groups were carried out with five medical tutors and 36 undergraduates. Interviews and focus groups were recorded, transcribed and thematically analysed. Results: The medical tutors and undergraduates identified suitability of appropriate subject specialties and years of teaching, whether learning objectives were important and if these had been achieved, and recommendations for future delivery. Discussion: Medical tutors were committed to delivering the health and work topics with the flexibility of tailoring the resources to existing subject specialties and with respect to the year of study. Learning objectives were perceived appropriate by tutors, despite ambivalence about their importance from some undergraduates. The resources were identified as having relevance to public health undergraduate teaching and teaching during general practice placements

Health and Work in Undergraduate Medical Education

Aims/Objectives/Background: We will present on a project commissioned by Public Health England (PHE) to develop a set of online curriculum resources on health and work that will be universally available to all UK medical schools. The aim of the project is to improve the health and work dialogue between doctors of the future and patients. Content of Presentation: The presentation will outline the process of co-producing curriculum resources via partnership between healthcare professionals, patient and public involvement representatives, academics and national government organisations. We will then set out the planned approach for piloting the new resources at medical schools in England to take place in autumn 2019. Relevance/Impact: The resources will help new doctors use the fit note as a practical advice system as well as a process for sickness certification. The background to this work lies within the Government’s national vision to reduce health-related worklessness and help individuals achieve their work and health potential, which it set out in its command paper Improving Lives: the Future of Work, Health and Disability. Outcomes: The set of learning resources and teaching aids is intended to provide knowledge, tools and techniques to improve future doctors’ confidence to start conversations with patients around health and work and the ‘fit note’. Discussion: The presentation will focus on the contribution both patients and medical undergraduates representatives have provided, which has increased both the quality and rigour of the resources. The barriers and enablers encountered in piloting the resources in medical schools will also be discussed

Piloting the Health and Work Curriculum in Undergraduate Medical Education in England

Background: We report on a project commissioned by the UK Government’s executive agency Public Health England (PHE) to develop and pilot a set of curriculum resources on health and work that were available to six medical schools in England. This project is underpinned by the 2018 Outcomes for Graduates developed by the UK’s General Medical Council (or GMC), which sets the standards for medical schools in the UK. It includes an expectation that newly qualified doctors will be able describe the principles of holding a fitness for work conversation with patients…and how to make referrals to colleagues and other agencies. The aim of this project was to improve the health and work dialogue between doctors of the future and patients. The background to this work lies within the UK Government’s national vision to reduce health-related worklessness and help individuals achieve their work and health potential, which it set out in its command paper Improving Lives: the Future of Work, Health and Disability. The purpose of the pilot was to answer the question, “Is it feasible to implement the teaching of health and work topics into the medical school curriculum?” Objectives The overarching aim of the project was to design and pilot an integrated curriculum for future doctors that addresses how to communicate with service users/patients about staying in and returning to work. Methods Qualitative and quantitative methods were employed involving telephone interviews with course tutors prior to and following the teaching pilot, student surveys and focus groups in each of the six medical schools who took part in the pilot. Results The results indicated: where aspects of the curriculum improved understanding of broaching health and work conversations; helped to recognise what factors facilitated further learning; what support and advice the tutors required to teach the materials, and where additional resources were needed to help deliver the teaching resources. Lastly, the results highlighted what some of the limitation were with introducing the health and work curriculum. Conclusions This pilot study showed it was possible to introduce a set of curriculum resources on health and work in English medical schools, with course tutors welcoming the opportunity of using a range of teaching materials aimed at undergraduate medical education

Social Prescribing and Integrated Care: An Evaluability Assessment

Background: The landscape of healthcare is in a constant state of flux universally. In the United Kingdom (UK) for instance, there is a desperate need to fund the National Health Service (NHS) to better reflect the populace at a local level. In response, the NHS Five Year Forward View was published and it was noted amongst other things that a “one size fits all” model of care was simply, no longer practical. As part of delivering this remit, new models of care have been designed to not only deliver more integrated care, but to create partnerships at the community level . One such model is the Encompass multispecialty community provider (MCP), which is one of 14 ‘vanguards’ established across the UK in response to improving the integration of health and social care whilst also looking towards non-clinical resolutions when appropriate. This necessity to pursue a more inclusive and sustainable approach to health has allowed concepts such as social prescribing to rise to prominence. The social prescribing service associated with this scheme; Red Zebra Community Solutions has been tailored to the needs of this MCP by referring and/or signposting patients to non-medical services (i.e. befriending services to combat social isolation) within the community. Based on the needs of the locality, this social prescribing service aims to: •Provide a referral database that will allow residents within the Encompass MCP catchment area to access local activities and services •Provide a social, rather than medical solution when suitable •Reduce the number of unnecessary appointments and hospital admission(s) Method: An evaluability assessment was undertaken of this local social prescribing service to determine if at present there was enough evidence to carry out a full evaluation of Red Zebra in relation to the MCP. It was agreed that the key criteria to consider were: •The quality of the project purpose •The quality of expected outputs •The availability of baseline and monitoring data •The feasibility of attribution Data Collection: To address the key criteria the research team collated and analysed information related to the Encompass MCP developed logic model for social prescribing and Red Zebra’s own narrative. This included Red Zebra’s history, aims, objectives, staff job descriptions, copies of client feedback forms and the social prescribing platform they utilise to undertake their work. In-person interviews were also undertaken with social prescribing managers and case officers as well as commissioners engaged with the Encompass MCP process. Conclusion: There is evidence of engagement with voluntary and community support services particularly amongst the older patient population for social isolation. Additionally, there is evidence that GPs are referring patients for social prescribing support although, it is not possible to determine whether Red Zebra itself has increased awareness of community support services among GPs or patients. Whilst promising, in future, the outcome data collected by Red Zebra will need to expand to include a formal assessment of client perceived benefits and anticipated outcomes of the service itself (i.e. measures of psychosocial wellbeing) to permit an evaluation