Ethnic inequalities during clinical placement: A qualitative study of student nurses' experiences within the London National Health Service.

AIM: To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups. DESIGN: A qualitative thematic analysis with an inductive approach. METHODS: Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement. RESULTS: Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as "ward culture") providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS. CONCLUSION: These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity. IMPACT: Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.

Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience.

AIM: To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum. MATERIAL AND METHODS: An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text. RESULTS: All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound. CONCLUSIONS: Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.

Where we came from: continuing professional development for the 18th century physician and surgeon, the genesis of British medical societies.

Keeping professionally up to date in 18th-century Britain was not an easy undertaking. Learning on the job was insufficient for the further development of individual medical knowledge. The century witnessed the gradual growth of medical societies to provide a better education than that offered by university institutions. The Worshipful Society of Apothecaries of London in 1815 was empowered to licence and regulate medical practitioners, today's general practitioners. Societies were established in Edinburgh but not so many as around London, where a particularly successful education body was established in 1773, the prestigious Medical Society of London. In 1805 a breakaway group from the society formed an equally highly respected learned body, the Medical and Chirurgical Society of London, that became the nidus for the amalgamation of numerous specialist societies to form, in June 1907, the extant Royal Society of Medicine. By the end of the 18th century, the medical society had fostered professionalism, education and unification within diverse medical and scientific disciplines.

A realist evaluation of a London general practitioner trainer course.

Clinicians with teaching and training roles should be adequately trained and assessed. However, some debate exists as to what the nature of this training should be. Historically, a postgraduate certificate in education was a pre-requisite to becoming a GP trainer but this is changing with growing concern that such a pre-requisite might act as a deterrent to potential GP trainers. This research examines the impact of a scheme designed to provide an alternative, more practical and focused, pathway to becoming a GP trainer. We interviewed 26 course participants and stakeholders of the London GP Training Course (LGPTC), observed teaching sessions, and analysed course materials. We asked what elements of the course were and weren't effective, for whom, and under what circumstances. Here, we present a summary of our main findings - that GP trainers want to know practically, not theoretically, how to be a trainer; formative assessment boosts trainees' confidence in their own skills and abilities; short, practical GP training courses can help enhance the numbers of GP trainers; important questions remain about the role and value of educational theory in education faculty development.

From clinical to corporate: opportunities for nurses away from the bedside.

Luke Evans, Education Fellow, UCLPartners, London, meets nurses whose careers have taken them from the NHS to a variety of different roles.

BEST of Surgical Training: the pan-London Core Surgical Training induction programme: "There's no I in team, but there is a me."

BACKGROUND: In the UK, Core Surgical Training (CST) marks the start of a surgical career, but previous experience and skills vary widely. Whilst Individual hospital Trusts offer local inductions, these are generally of a generic, administrative nature rather than advising trainees on how best to harness training opportunities. We designed a regional induction programme, 'Building Excellence in Surgical Training' (BEST) to address this, develop essential technical and non-technical skills, and engender support networks. METHODS: All incoming London Core Surgical Trainees (annual cohort size 90) were invited to participate, during the week prior to commencement of training. Trainees undertook 3 modules (portfolio, surgical skills and human factors-based simulation) and a research paper presentation day. We collected qualitative and quantitative data through a structured evaluation form, pre and post course Likert-scale scores and self-assessment utilising the non-technical skills for surgeons (NOTSS) framework. RESULTS: 972 CSTs have completed BEST over the past 12 years. In 2019, significant improvements were seen in: confidence for starting CST, 45% (n = 22/49)-83% (n = 33/40,p = 0.00045); feeling the core programme cared about them, 55% (n = 27/49)-98% (n = 41/42, p =< 0.00001); getting to know peers 16% (n = 8/49)-88% (n = 35/40, p =< 0.00001); understanding human factors 82% (n = 40/49)-95% (n = 36/38, p = 0.00427); gaining confidence of trainers, 49% (n = 23/47)-86% (n = 31/36, p = 0.00114), and ability to speak out over patient safety concerns, 78% (n = 38/49)-97% (n = 37/38,p = 0.00019). NOTSS assessments showed significant improvement across all 4 criteria (n = 142, p =< 0.00001). CONCLUSION: BEST equips trainees with the fundamental skills and confidence to safely embark on surgical training and provides tools to navigate the challenges training presents. The ethos of collaboration and support will aid the development of more resilient and empowered surgeons, vital in this era.

Do fellowships for newly qualified GPs improve retention? Evaluation of London's SPIN New to Practice Fellowships.

BACKGROUND: We explored whether having a variety of work roles and extra support during the first 2 years after qualifying would retain general practitioners (GPs) in London. Newly qualified GPs were offered a Fellowship comprising permanent salaried positions, part-time (portfolio) roles outside general practice and peer support for 1-2 years. METHODS: We surveyed newly qualified GPs taking part in the Fellowship near the beginning of their Fellowship (91) and again after 8-10 months (93). We interviewed 34 newly qualified GPs taking part in the Fellowship and 20 who were not. We surveyed and interviewed representatives from employing practices (171), organisations hosting portfolio roles (20), those facilitating the Fellowship (10) and other stakeholders (43). FINDINGS: Over a 2.5-year period, employers recruited and retained 425 newly qualified GPs to salaried posts using the Fellowship. Eighty-eight per cent of the newly qualified GPs taking part said they intended to stay working in local practices. They said that undertaking a portfolio role helped them feel valued, had more variety and integration with the wider professional community. Those with two or more portfolio sessions per week were the most positive. CONCLUSIONS: Portfolio roles and peer support may increase newly qualified GPs intention to stay working in salaried posts, however it is too early to say whether these intentions will translate into behaviour. WHAT THIS EVALUATION ADDS TO CURRENT KNOWLEDGE: Portfolio roles and monthly peer support helped newly qualified GPs feel supported and valued, which may influence their intention to stay working in general practice locally.

Dental public health in action: foundation dentists' delivery of an oral health promotion outreach project for people experiencing homelessness in London.

Dental public health in action: foundation dentists' delivery of an oral health promotion outreach project for people experiencing homelessness in London.Within a decade, the UK has seen a dramatic increase in homelessness. This is defined as being without an available home that could reasonably be occupied. The increase has been driven by increasing poverty, welfare reform, cuts to public services and lack of affordable housing (Bramley et al., 2015; Fitzpatrick et al., 2013; Fitzpatrick et al., 2018). Rough sleeping in England alone has increased by 2,909 people or 165% since 2010 (Ministry of Housing, Communities and Local Government, 2018). This increase has been particularly visible in London (National Audit Office, 2018), where approximately a quarter of the country's rough sleepers reside (Ministry of Housing, Communities and Local Government, 2018).

Providing support and raising awareness of a delicate subject.

Clare Akers, Clinical Nurse Practitioner, University College London Hospitals NHS Foundation Trust, was runner up in the urology nurse of the year category in the BJN Awards 2020.

[The St. Petersburg medicine of the late 1820s as seen by London physician].

The article considers the condition of medicine in St. Petersburg in 1827-1828 as presented in memoirs of English physician A. B. Granville about his visiting the capital of Russia. The prominent physician and naturalist, familiar with condition of medicine in main countries of Europe, he provided substantial and objective characteristic of condition of medicine and health care in Russia. This characteristic, coming from independent and competent observer, permits to correct conceptions about condition of Russian medicine during the period when the results of modernization of the Russian Empire of XVIII-early XIX centuries manifested in full measure effecting becoming of Russian school of medicine.

Royal College of Physicians of London: a 1793 entrant, fabled fellow or member malcontent.

The adverse fallout following the Royal Australasian College of Physician's (RACP) introduction to computer-based testing that was disrupted in the February 2018 examinations, aroused great sympathy for the candidates and perhaps rekindled worrying memories by the College fellowship. The RACP's entrance procedures have slowly and steadily evolved since 1938 when the first 41of 45 practitioners were admitted to membership. Powerful emotive experiences accompany most applicants' progress to membership, perhaps no greater an ordeal than visited upon a 1793 anonymous entrant to the Royal College of Physicians of London, facing far different but no less stressful predicaments.

John Houghton and Medical Practice in London c. 1700.

This article considers the evidence for medical practice in London c. 1700 provided by A Collection for the Improvement of Husbandry and Trade (1692-1703) by the apothecary and Fellow of the Royal Society, John Houghton (1645-1705). Houghton discusses how products are used medicinally, as well as the necessary qualifications for a physician, and reports his own experiments and health experiences. His advertisements reveal the range of (largely medical) products he could himself supply, but he also offered an information service, often for medical practitioners, throwing light on both the supply and demand for medical practitioners in different communities and the desirable attributes of shops. Whereas most sources used to uncover medical practice highlight conflict and competition, Houghton's approach emphasizes consensus and cooperation, partly for his own ideological and commercial reasons, and partly reflecting the emergence of new forms of medical practice supported by the new science and by genteel consumer demand.

Chelsea, Pimlico and Belgravia District Nursing Association 1930-1939: A case study.

The case study explores how the expansion of the health services during the interwar period impacted upon the status of district nursing and examines how being a voluntary service shaped district nursing associations. A range of primary sources were used; the Association Annual Reports, the Medical Officer for Health Annual Reports for the Borough of Chelsea, the Ministry of Health records, the archives of the Queen's Nursing Institute (QNI) and the Borough of Chelsea Council Minutes. The Medical Officer for Health Reports and the Council minutes identify efforts to improve environmental factors that impacted upon health. These primary sources briefly note the contribution of the Association suggesting that it was integral to the health care provision but considered a constant. The impact of changes to the 1932 Sunday Entertainments Act provide an interesting juxtaposition between the acknowledged value of district nursing and the constant struggle to fundraise in order to provide home nursing. Throughout the 1930s the Association experienced staff shortages and challenges regarding recruitment. The complexities of payment for municipal health services following the 1929 Local Government Act contributed to the staffing challenges. The move to a block grant in 1938 provided increased stability with regards to income. The case study identifies a contradiction regarding the esteem and value placed upon district nursing associations providing home nursing and the constant challenge of resources. District nursing services face similar challenges and this is the 130th anniversary of the Queen's Nursing Institute.

How to tackle the dearth of nurses.

Ben Morrin and Flo Panel-Coates analyse the cause and effect of nurse shortage plaguing the city of London.

Rethinking industrial citizenship: the role and meaning of work in an age of austerity.

T. H. Marshall in his famous tract Citizenship and Social Class wrote briefly about what he called 'industrial citizenship', a type of belonging rooted in the workplace. Here Marshall's ideas are developed alongside a consideration of Durkheim's Professional Ethics and Civic Morals together with research material from the Guinness Company. It shows the way the Company actively sought to create 'Guinness citizenship' within its London brewery. The article draws out the ways in which the significance and potential of work based citizenship for ameliorating the ills of industrial society are clearly articulated in mid-twentieth century Britain and echo earlier neglected Durkheimian sociological ideas on work. These ideas have real potential to inform contemporary academic and policy debates about the nature of capitalism and the form and content of work now and in the future.

Ron Gain and his dental practice before and during the Second World War.

A history of Ronald Gain's dental practice is described including his service during the Second World War. An account is given of the bomb damage in and around the practice in Peckham Rye.