Why patients take part in the Royal College of Physicians Practical Assessment of Clinical Examination Skills (MRCP PACES).

The aim of this study was to examine patients' motivation to participate in the Royal College of Physicians Practical Assessment of Clinical Examination Skills (PACES). An exploratory cross-sectional study was performed with data collected via telephone interviews. All patients aged 18+ who participated in PACES at University Hospitals Coventry and Warwickshire in the last two years were invited to take part; 28 patients were interviewed. Data were analysed using thematic content analysis. Motivational factors identified included the opportunity to give something back for the care received, contributing to doctors' learning processes, altruism and being able to learn more about one's own condition. Patients believed that they offered real-life experiences that cannot be provided by actors. The social environment during PACES played a large part in volunteer retention. Recruitment of patient volunteers needs to emphasise the altruistic nature of the role in assisting the learning process for doctors and the subsequent benefit for future patients.

"Understanding where you're coming from": discovering an [inter]professional identity through becoming a peer facilitator.

Peer facilitation offers an innovative and effective means of promoting interprofessional learning (IPL) between health and social care students. This paper highlights the benefits that peer facilitators themselves experience from involvement in assisting junior colleagues to engage with IPL in an online context. The setting for the inquiry is an online interprofessional learning pathway shared by two higher education institutions in the UK. Insights have been developed over a 3-year period through collaborative inquiry with 41 peer facilitators, academic tutors and the students who benefitted from their input. This paper which focuses on peer facilitators' application data, interview data and written reflections explores the instrumental, cognitive and personal gains experienced. However, more fundamentally, theorizing findings in relation to identity theory we substantiate the claim that the role provides opportunity for testing and refining important aspects of both professional and interprofessional identities.

Electronic risk assessment for venous thromboembolism: investigating physicians' rationale for bypassing clinical decision support recommendations.

OBJECTIVE: The underutilisation of venous thromboembolism (VTE) prophylaxis is still a problem in the UK despite the emergence of national guidelines and incentives to increase the number of patients undergoing VTE risk assessments. Our objective was to examine the reasons doctors gave for not prescribing enoxaparin when recommended by an electronic VTE risk assessment alert. DESIGN: We used a qualitative research design to conduct a thematic analysis of free text entered into an electronic prescribing system. SETTING: The study took place in a large University teaching hospital, which has a locally developed electronic prescribing system known as PICS (Prescribing, Information and Communication System). PARTICIPANTS: We extracted prescription data from all inpatient admissions over a 7-month period in 2012 using the audit database of PICS. INTERVENTION: The completion of the VTE risk assessment form introduced into the hospital-wide electronic prescribing and health records system is mandatory. Where doctors do not prescribe VTE prophylaxis when recommended, they are asked to provide a reason for this decision. The free-text field was introduced in May 2012. PRIMARY AND SECONDARY OUTCOME MEASURES: Free-text reasons for not prescribing enoxaparin when recommended were thematically coded. RESULTS: A total of 1136 free-text responses from 259 doctors were collected in the time period and 1206 separate reasons were analysed and coded. 389 reasons (32.3%) for not prescribing enoxaparin were coded as being due to 'clinical judgment'; in 288 (23.9%) of the responses, doctors were going to reassess the patient or prescribe enoxaparin; and in 245 responses (20.3%), the system was seen to have produced an inappropriate alert. CONCLUSIONS: In order to increase specificity of warnings and avoid users developing alert fatigue, it is essential that an evaluation of user responses and/or end user feedback as to the appropriateness and timing of alerts is obtained.

ExPeKT--Exploring prevention and knowledge of venous thromboembolism: a two-stage, mixed-method study protocol.

INTRODUCTION: There is little awareness of venous thromboembolism (VTE) in the public arena. Most commonly known causes are-travellers' thrombosis and thrombosis associated with oral contraception, both frequently referred to in the media. However, VTE is a substantial healthcare problem, resulting in mortality, morbidity and economic cost. Most hospitalised patients have one or more risk factors for VTE. Around 60% of people undergoing hip or knee replacement will suffer a deep vein thrombosis without preventative intervention. Studies demonstrate a risk reduction for VTE of up to 70% with preventative medicine for medical and surgical conditions: cancer, orthopaedic surgery, general surgery and acutely ill medical admissions. Results will be used to identify methods of increasing knowledge of VTE prevention and for the development of educational and patient information materials. METHODS AND ANALYSIS: A two-stage, mixed-method study using surveys with primary healthcare professionals and patients followed by interviews with primary healthcare professionals, patients, acute trusts and other relevant organisations. Survey and qualitative interview data will examine the current practice of thromboprophylaxis, and the knowledge and experience of VTE prevention for the development of education initiatives for primary healthcare professionals and patients to adopt thromboprophylaxis outside the hospital setting. As this is a scientific exploratory study for the generation, rather than testing, of new hypotheses a sample-size analysis is not called for. Survey data will be analysed using SPSS version 20. Open-ended responses will be analysed using qualitative thematic methods. The recorded and transcribed semistructured interview data will be analysed using constant comparative methods. ETHICS AND DISSEMINATION: Ethics approval has been provided by the National Research Ethics Committee (reference: 11/H0605/5) and site-specific R&D approval granted by the relevant R&D National Health Service trusts. Findings will be disseminated at healthcare and academic conferences and written for peer-reviewed publication. TRIAL GRANT NUMBER: NIHR RP-PG-0608-10073.

Understanding metaphor to facilitate emotional expression during a chronic disease self-management course.

OBJECTIVE: This study was designed to understand emotional expression as an element of the chronic disease self-management course (CDSMC). METHODS: Interpretive phenomenological analysis (IPA) was used to analyse a qualitative interview data set in which 10 lay-tutors described their perceptions of emotional expression during a CDSMC. The accounts were used to develop an interpretive phenomenological account. RESULTS: Tutors suggest that people on a CDSMC are often unaware of their own emotional state and lack the vocabulary for expression. Tutors use metaphorical language to help Course participants to identify their own feelings and construct meaning of their illness experiences. 'Off-loading' and 'feeling blue' are used to help them find the expressions to talk about their emotions and release their feelings. CONCLUSION: Tutors use metaphoric terms as a framework for the understanding of emotional states that Course participants often find 'difficult to label'. The analogous structure of metaphor helps with the understanding of inner feelings and provides expressive phrases for dialogue that can lead to emotional relief. PRACTICE IMPLICATIONS: This study provides important considerations that could be applied when training CDSMC tutors to help facilitate emotional understanding and expression.