Evaluating a novel intervention in undergraduate medicine: an MBBS Curriculum Map.

BACKGROUND: Following student feedback, a Curriculum Map (CM) was commissioned in 2018 at UCL Medical School (UCLMS). After exploring key requirements of a CM, the second phase focused on building a prototype before its launch. This study evaluates this novel pedagogical intervention following its implementation, from the perspective of its primary users, UCL medical students. METHODS: This multi-method study was conducted two months after the CM's launch in 2019. Quantitative and qualitative data was gathered via a survey and focus groups across four domains: usefulness, satisfaction, appearance, and content. Reflective Thematic Analysis was used to analyse the qualitative data to build themes. RESULTS: One hundred ninety five participants (195/1347, 14%) responded to the survey and two focus groups were held. Higher rates of satisfaction were seen among later years compared to early years students. Five key themes emerged on the CM as a: UCLMS textbook; learning aid for assessments; tool for capturing scientific content; modern learning technology and tool for 'levelling the playing field'. Key findings suggest that while students welcomed a centralised resource to create transparency, there were clear differences between early and later years students, with the former preferring a more prescriptive approach. Learning was assessment-driven across all years and students highlighted their desire for greater clarity on the importance of curricular content for summative assessments. CONCLUSION: A CM provides a benchmark for medical educators on the undergraduate curriculum, which must be balanced with its limitations; a CM cannot provide an exhaustive syllabus and needs to be supplemented with self-directed learning and clinical preparation for practice.

Approaching an undergraduate medical curriculum map: challenges and expectations.

BACKGROUND: Feedback received from medical students at University College London Medical School (UCLMS) suggested a lack of clarity regarding the contents and subsequent assessment of the undergraduate curriculum. In order to address these issues, a specialist team was established with the aim of designing and implementing a Curriculum Map (CM), which have been recognised in their ability to provide a centralised, visual representation of the curriculum. While multiple perspectives from educators to stakeholders can be considered here, the need for the CM to remain student centred was identified as key at UCLMS. The aim of this study was therefore to understand the requirements of the CM prior to production from the perspective of the medical students. METHODS: A mixed-methods sequential study was conducted. The first stage involved gathering quantitative data using a primary online survey. This used 15 questions, rated by Likert scales and focussed around three domains: depiction of content, functionality and students' likely engagement with a CM. There was a free-text question for additional comments. The second stage consisted of multiple student focus groups representing different years of the programme, conducted by trained facilitators following a predetermined scheme. Reflective Thematic Analysis (RTA) was used to synthesise the qualitative data, which was read independently by two researchers. All students at UCLMS were invited to participate in the study. RESULTS: There were 409 survey responses. 92% of students said they were 'likely' or 'very likely' to use a CM, with their key intended use being to monitor their learning progress and ensure preparedness for assessments. Five key themes emerged from the focus groups, namely that students wanted a CM to be: comprehensive; simple and intuitive; able to link content throughout the course; aligned with assessment; and useful to monitor students' progress. CONCLUSIONS: Through this study, valuable insight was gained on students' ideal preferences for the CM. Understanding this was important in order to ensure that its co-design remained student-centred prior to its design and launch. This study also highlighted the need to set realistic expectations for students on the role of a CM in preparing them for assessments, and ultimately professional practice.

What should medical students be taught about abortion? An evaluation of student attitudes towards their abortion teaching and their future involvement in abortion care.

BACKGROUND: One in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students' opinions of this teaching and their wider attitudes towards abortion. METHODS: We invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests. RESULTS: One hundred and forty-six questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). Fifty-seven percent felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students' attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life. CONCLUSIONS: The majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women's healthcare, and may contribute to destigmatising abortion.

Improving patient safety by enhancing raising concerns at medical school.

BACKGROUND: Doctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula. We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience. METHODS: The authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students (n = 363) as well as voluntary attendance focus groups (n = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers. RESULTS: The authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum. CONCLUSIONS: More research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.

Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools.

BACKGROUND: A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools. AIMS: To investigate the evolution and structure of palliative care teaching at UK medical schools. DESIGN: Anonymised, web-based questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools. RESULTS: The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1-16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%). CONCLUSION: Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.

Progress and divergence in palliative care education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning.

BACKGROUND: Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown. AIM: To investigate palliative care training at UK medical schools and compare with data collected in 2000. DESIGN: An anonymised, web-based multifactorial questionnaire. SETTINGS/PARTICIPANTS: Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000. RESULTS: All continue to deliver mandatory teaching on 'last days of life, death and bereavement'. Time devoted to palliative care teaching time varied (2000: 6-100 h, mean 20 h; 2013: 7-98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include 'involvement in clinical areas', participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students' assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally. CONCLUSION: Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.

Schwartz Centre Rounds: a new initiative in the undergraduate curriculum-what do medical students think?

BACKGROUND: Training to be a doctor and caring for patients are recognized as being stressful and demanding. The wellbeing of healthcare professionals impacts upon the wellbeing and care of patients. Schwartz Centre Rounds (SCRs), multidisciplinary meetings led by a trained facilitator and designed for hospital staff, were introduced to enhance communication and compassion, and have since been widely adopted as a way of fostering compassion. The continuum of education suggests that medical students need to develop these attributes in conjunction with resilience and maintaining empathy. The benefits of SCRs in fostering this development in medical students is unexplored. The objective of this study was to examine the potential of SCRs within the undergraduate curriculum. METHODS: Two student-focused SCRs were piloted at a major medical school. The sessions were based on the current format implemented across the US and UK: a presentation of cases by a multidisciplinary panel followed by an open discussion with the audience. Participants were asked to complete an evaluative questionnaire immediately following the sessions. Seven students took part in a focus group to explore their views on the SCR. Data sets were examined using descriptive statistics and thematic analysis. RESULTS: Feedback was obtained from 77 % (258/334) Year 5 and 37 % (126/343) Year 6 students. Mean student ratings of the session on a five-point scale, where 1 = poor and 5 = exceptional, were 3.5 (Year 5) and 3.3 (Year 6). Over 80 % of respondents either agreed or strongly agreed that the presentation of cases was helpful and gave them insight into how others feel/think about caring for patients. Eighty percent said they would attend a future SCR and 64 % believed SCRs should be integrated into the curriculum. Focus group participants felt SCRs promoted reflection and processing of emotion. Students identified smaller group sizes and timing in the curriculum as ways of improving SCRs. CONCLUSION: Students were positive about SCRs, preferring them to their current reflective practice assignments. Whether this results in sustained benefits to trainee doctors is yet to be explored. Consideration is given to overcoming the challenges that were encountered, such as optimal timing and participation. Staff training and costs are potential obstacles to adoption.

Design, implementation and evaluation of a spiral module combining data science, digital health and evidence-based medicine in the undergraduate medical curriculum: A mixed methods study.

BACKGROUND: Digital health, data science and health informatics are increasingly important in health and healthcare, but largely ignored in undergraduate medical training. METHODS: In a large UK medical school, with staff and students, we co-designed a new, 'spiral' module (with iterative revisiting of content), covering data science, digital health and evidence-based medicine, implementing in September 2019 in all year groups with continuous evaluation and improvement until 2022. RESULTS: In 2018/19, a new module, 'Doctor as Data Scientist', was co-designed by academic staff (n = 14), students (n = 23), and doctors (n = 7). The module involves 22 staff, 120 h (43 sessions: 22 lectures, 15 group and six other) over a 5-year curriculum. Since September 2019, 5,200 students have been taught with good attendance. Module student satisfaction ratings were 92%, 84%, 84% and 81% in 2019, 2020, 2021 and 2022 respectively, compared to the overall course (81%). CONCLUSIONS: We designed, implemented and evaluated a new undergraduate medical curriculum that combined data science and digital health with high student satisfaction ratings.

Medical student perceptions of reflective practice in the undergraduate curriculum.

Introduction: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students' attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. Methods: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. Results: Five key themes emerged around student attitudes to RP, which were grouped into three domains: 'value of RP', 'barriers to engagement', and 'strategies for enabling RP'. 'Value of RP' centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. 'Barriers to engagement' centred on the purpose and tokenism of RP and in the third domain, 'strategies for enabling RP', the theme of student agency in RP emerged strongly. Conclusion: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum.

'You've got mail!': Clinical and practical skills teaching re-imagined during COVID-19.

With the outbreak of COVID-19, there was widespread cessation of face-to-face teaching in medical schools from March 2020. 130 students in their first clinical year at a large London medical school were at risk of missing part of their clinical and practical procedure teaching. We mailed a teaching pack containing clinical consumables and gave instructions to prepare fruit, vegetables and kitchen sponges as a replacement for manikins. Students used cucumbers for bladder catheterisation, oranges for injections, bananas for suturing and cannulated sponges for practising intravenous drug administration. A student evaluation after the course was favourable. Hands-on practice had a positive effect on the students' feelings of belongingness and identity and helped them feel like they were not missing out or being left behind. Technology was challenging for both students and tutors. The intervention is being repeated for all incoming students from September 2020.

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors' professional behaviours and attitudes towards the regulator.

OBJECTIVE: This paper examines the impact on doctors' attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case. DESIGN: A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case. SETTING: Primary and secondary care settings across a broad geographical spread in England. PARTICIPANTS: 474 doctors. OUTCOME MEASURES: Attitudes towards the GMC and two professional behaviours in TPB dimensions. RESULTS: Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC's disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors' attitudes or intention to reflect or raise concerns. CONCLUSIONS: The lack of change in doctors' attitudes towards the GMC's guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors' trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors' overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.

Practical tips for teaching academic integrity in the digital age.

This article was migrated. The article was marked as recommended. Background: Medical education, as with other areas of healthcare education, is susceptible to cheating, with national and international examples cited in the literature. There are documented examples in the lay press, but limited scholarly activity in the field, which can be a challenging area to research and tackle. We have begun to explicitly address academic integrity within our undergraduate curriculum, including a focus on plagiarism, self-plagiarism, and covert sharing of questions. We believe this is an important curricular topic as exhibiting unprofessional behaviours can correlate with professional practice and can potentially have implications for practitioners and patients. Aim: To present 12 tips on teaching academic integrity in the digital age to medical students. Method: The tips presented are based on our experiences of teaching academic digital integrity to medical students, primarily in the form of a scenario based quiz. We do also extrapolate from content on academic integrity elsewhere within our professionalism syllabus. Results: The tips suggest that early, contemporary and contextualised material that is co-produced with students may offer a useful prophylactic approach to teaching about academic integrity. Conclusions: The principles presented could be adapted to other healthcare students and settings, including postgraduate education.

Twelve tips for teaching medical students about female genital mutilation (FGM).

This article was migrated. The article was marked as recommended. Background: Seeing women or girls from FGM practising communities can be a challenge for healthcare professionals, involving a complex interplay of professional duties, legal requirements, social and cultural understanding, and sensitive, skilled communication. Aims and methods: Robust training on how to identify and support women and girlswho have undergone or who are at risk of FGM , including fulfilling FGM-related legal duties,is essential for healthcare professionals. We believe it is important that this training begins in medical school so that junior doctors feel prepared to talk to women and girls from FGM practising communities as soon as they qualify and start work. Results: We have reviewed the limited existing literature on teaching medical and other healthcare students about FGM and have drawn on our many years of providing well-evaluated teaching sessions on FGM at UCL Medical School to design twelve tips as a blueprint for running sensitive and effective undergraduate teaching on FGM. Conclusions: Effective teaching for medical students on FGM is important and feasible . Curricula leads and individual teachers will benefit from a structured, comprehensive and culturally sensitive approach outlined in the twelve tips.

LGBT+ Health Teaching within the Undergraduate Medical Curriculum.

: Introduction: The lesbian, gay, bisexual, and transgender (LGBT+) population experience health and social inequalities, including discrimination within healthcare services. There is a growing international awareness of the importance of providing healthcare professionals and students with dedicated training on LGBT+ health. METHODS: We introduced a compulsory teaching programme in a large London-based medical school, including a visit from a transgender patient. Feedback was collected across four years, before (n = 433) and after (n = 541) the session. Student confidence in using appropriate terminology and performing a clinical assessment on LGBT+ people was assessed with five-point Likert scales. Fisher exact tests were used to compare the proportion responding "agree" or "strongly agree". RESULTS: Of the students, 95% (CI 93-97%) found the teaching useful with 97% (96-99%) finding the visitor's input helpful. Confidence using appropriate terminology to describe sexual orientation increased from 62% (58-67%) to 93% (91-95%) (Fisher p < 0.001) and gender identity from 41% (36-46%) to 91% (88-93%) (p < 0.001). Confidence in the clinical assessment of a lesbian, gay or bisexual patient increased from 75% (71-79%) to 93% (90-95%) (p < 0.001), and of a transgender patient from 35% (31-40%) to 84% (80-87%) (p < 0.001). DISCUSSION: This teaching programme, written and delivered in collaboration with the LGBT+ community, increases students' confidence in using appropriate language related to sexual orientation and gender identity, and in the clinical assessment of LGBT+ patients.

Preparing future doctors for palliative care: views of course organisers.

BACKGROUND: Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown. OBJECTIVE: To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction. METHODS: An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools. RESULTS: Data were obtained from all 30 UK medical schools. Organisers agreed/strongly agreed (=agreed) that their PC course was highly rated by students (26, 87%). 25 (83%) agreed their course 'enabled misconceptions and fears about PC, death, dying and bereavement to be addressed', 'delivered quality PC training' (23, 77%), 'fulfilled General Medical Council requirements' (19, 63%), 'prepared students well to care for patients with PC/EOLC needs' (18, 60%) and 'enabled students to visit a hospice and see the role of doctors in caring for the dying' (17, 57%). Concerns were limited capacity to accommodate students (agreed 20, 66%) and variability in teaching according to location (15, 50%). Most agreed their institution recognised PC training as important (22, 73%), they felt supported by colleagues (21, 70%) and experienced cooperation between stakeholders (20, 67%). All agreed that PC training was essential for undergraduates, while 29 (97%) supported inclusion of a hospice visit in the curriculum. 27 agreed that their role was satisfying (90%), 3 disagreed (10%). CONCLUSIONS: Approximately two-thirds of organisers were generally positive about their PC course, institution and role. A minority expressed concerns; these may reflect suboptimal PC training at their medical school and poor preparation of new doctors.

Enabling honest reflection: a review.

BACKGROUND: Reflective practice provides a backbone to professionalism, a commitment to lifelong learning and competency-based education in the form of reflective portfolios. Changes in health care culture have promoted a move towards openness and reflection on challenging clinical encounters. ISSUE: Engagement with reflection has historically proved challenging to clinical educators. This Faculty Development Review examines this using a case study from the UK in which a postgraduate trainee was asked to disclose their reflective portfolio by a patient's legal representation. Critics have consequently questioned whether the educational benefit of reflection warrants these potential legal implications. In the context of pressure from accrediting bodies to demonstrate evidence of reflection, how can learners face this potential conflict of professional versus legal repercussions? EDUCATIONAL RATIONALE: We combine professional guidance from the UK and educational rationale from international settings to produce a guide for good practice. We offer guidance on facilitating reflection for learners in an open and honest way without diluting educationally effective critical reflection. Themes of anonymity, taking a balanced approach, seeking senior advice, focusing on learning outcomes and role-modelling are discussed. How can learners face this potential conflict of professional versus legal repercussions? TAKE-HOME MESSAGES: Integrating reflection within the curriculum improves engagement and is key to experiential learning. Clinical educators should be aware of legal and professional guidance applicable to their own context. Both educators and learners should be aware that written reflection is an educational not a clinical tool, and so requires little or no patient-identifiable data, thereby ensuring safer reflective practice.