Twelve tips for designing and implementing peer-led assessment writing schemes in health professions education.

Peer-led assessment (PLA) has gained increasing prominence within health professions education as an effective means of engaging learners in the process of assessment writing and practice. Involving students in various stages of the assessment lifecycle, including item writing, quality assurance, and feedback, not only facilitates the creation of high-quality item banks with minimal faculty input but also promotes the development of students' assessment literacy and fosters their growth as teachers. The advantages of involving students in the generation of assessments are evident from a pedagogical standpoint, benefiting both students and faculty. However, faculty members may face uncertainty when it comes to implementing such approaches effectively. To address this concern, this paper presents twelve tips that offer guidance on important considerations for the successful implementation of peer-led assessment schemes in the context of health professions education.

Raising professionalism concerns as a medical student: damned if they do, damned if they don't?

BACKGROUND: Understanding professionalism is an essential component of becoming a doctor in order to ensure the trust of patients and wider society. Integrally linked to the concept of professionalism is the importance of identifying and raising concerns to ensure high quality, safe patient care. It is recognised that medical students are uniquely placed to identify and report concerns given their frequent rotations through multiple clinical placements and their peer relationships and, in so doing, develop and enact their own medical professionalism. Although there is existing literature exploring medical students' willingness to raise concerns about observed professionalism lapses, this has largely been in the context of clinical interactions. Medical students will however undoubtedly encounter concerning behaviours or attitudes in their fellow students, an area that has not specifically been reported upon. This study therefore set out to explore medical students' willingness to report professionalism concerns they encounter both within and away from the clinical setting, particularly focusing on peer-related concerns. METHODS: 10 medical students, in later clinical years of a large UK medical school, volunteered to take part in in-depth semi-structured interviews. Interviews were recorded, transcribed and then analysed thematically to generate themes and subthemes to represent central organising concepts. RESULTS: Three broad themes were generated from the data. Hidden curricular effects including role models, hierarchical structures and the operational systems in place to raise concerns subconsciously influenced students' decisions to raise concerns. Secondly, students offered a range of justifications to defend not taking action, including considering their own vulnerabilities and values alongside demonstrating empathy for perceived mitigating circumstances. The third theme highlighted the complex interplay of influencing factors that students considered when encountering professionalism issues in their peers including wider peer cohort effects and a desire to maintain individual peer-relationships. CONCLUSIONS: Medical students will inevitably encounter situations where the professionalism of others is brought into question. However, despite clear curricular expectations to report such concerns, these findings demonstrate that students undergo a complex decision-making process in determining the threshold for reporting a concern through navigating a range of identified influencing factors. This study highlights the important role medical schools play in helping reduce the inner conflict experienced by medical students when raising concerns and in ensuring they provide supportive processes to empower their students to raise concerns as part their own developing professionalism.

Evaluating the impact of a teaching course for GP speciality trainees.

INTRODUCTION: Near-peer teaching offers mutual benefits for clinical trainees and the students they teach. However, General Practice Speciality Trainees (GPSTs) are typically less involved in community-based teaching than their hospital-based peers and often do so without formal pedagogical training. This study details the immediate and longer-term evaluation of a teaching skills course delivered to final year GPSTs. It addresses a gap within existing near-peer literature which, although extensive, is predominantly hospital-based and limited to short-term outcomes. METHODS: The course was designed and delivered to all local final year GPST schemes. Pre- and post-course questionnaires scoring confidence, comfort, and understanding of teaching roles were analysed across two years' delivery. Furthermore, individual interviews of participants 4-6 months after attendance were thematically analysed to explore how GPSTs translated course content into practice. RESULTS: GPSTs reported a decline in their teaching activities as they embarked on their final year of GP teaching. Immediate post-course teaching-related confidence and knowledge scores increased. However, follow-up interviews revealed that GPSTs' initial enthusiasm was short-lived and outweighed by competing demands within an intensive short-duration training scheme. They expressed concerns about their own learner status as they themselves developed competency in a vast and varied speciality, and cited a lack of support from their trainers. CONCLUSIONS: Teaching skill courses alone are insufficient to address the ongoing challenges of enhancing the teaching role of GPSTs. Further work is now needed to explore multi-level interventions to promote the role of GPSTs as near-peer teachers to harness the mutual benefits to all involved.

Assessing clinical reasoning in the OSCE: pilot-testing a novel oral debrief exercise.

INTRODUCTION: Clinical reasoning (CR) is a complex skill enabling transition from clinical novice to expert decision maker. The Objective Structured Clinical Examination (OSCE) is widely used to evaluate clinical competency, though there is limited literature exploring how this assessment is best used to assess CR skills. This proof-of-concept study explored the creation and pilot testing of a post-station CR assessment, named Oral Debrief (OD), in the context of undergraduate medical education. METHODS: A modified-Delphi technique was used to create a standardised domain-based OD marking rubric encapsulating the key skills of CR that drew upon existing literature and our existing placement-based CR tool. 16 OSCE examiners were recruited to score three simulated OD recordings that were scripted to portray differing levels of competency. Adopting a think-aloud approach, examiners vocalised their thought processes while utilising the rubric to assess each video. Thereafter, semi-structured interviews explored examiners' views on the OD approach. Recordings were transcribed, anonymised and analysed deductively and inductively for recurring themes. Additionally, inter-rater agreement of examiners' scoring was determined using the Fleiss Kappa statistic both within group and in comparison to a reference examiner group. RESULTS: The rubric achieved fair to good levels of inter-rater reliability metrics across its constituent domains and overall global judgement scales. Think-aloud scoring revealed that participating examiners considered several factors when scoring students' CR abilities. This included the adoption of a confident structured approach, discriminating between relevant and less-relevant information, and the ability to prioritise and justify decision making. Furthermore, students' CR skills were judged in light of potential risks to patient safety and examiners' own illness scripts. Feedback from examiners indicated that whilst additional training in rubric usage would be beneficial, OD offered a positive approach for examining CR ability. CONCLUSION: This pilot study has demonstrated promising results for the use of a novel post-station OD task to evaluate medical students' CR ability in the OSCE setting. Further work is now planned to evaluate how the OD approach can most effectively be implemented into routine assessment practice.

Developing a career as a GP educationalist: contemporary challenges and workforce solutions.

GP educationalists are crucial in training the future medical workforce and in developing and advancing the field of primary care medical education, yet opportunities in the UK are patchy and varied. In this article, a group of GP educationalists summarise the challenges facing the sustainability of this particular group of clinical academics and outline opportunities available at each career stage, from medical students through to senior GP educationalists. Recommendations to support the growth of this workforce include the development of a nationally recognised framework for GP educationalist careers, collaboration with professional and educational bodies and taking steps to level out opportunities in order to reduce existing inequity.

Gaining ethics approval for health professions education research.

Within health professions education (HPE), there is a well-established and expanding literature offering empirical evidence to inform pedagogic practice. Research ethics refers to the set of professional standards and principles that should be followed to ensure that work is conducted in a responsible and legitimate manner. Conducting scholarly inquiry within educational practice can be categorized as either research or evaluation, but boundaries between the two approaches may be blurred. Ethical risks in HPE research include coercion, psychological stress and infringement upon data privacy. This review considers ethical considerations at each stage of the research process and makes practical recommendations for the HPE researcher.

Co-creating scholarship through collaborative writing in health professions education: AMEE Guide No. 143.

This AMEE guide provides a robust framework and practical strategies for health professions educators to enhance their writing skills and engage in successful scholarship within a collaborative writing team. Whether scholarly output involves peer-reviewed articles, book chapters, blogs and online posts, online educational resources, collaborative writing requires more than the usual core writing skills, it requires teamwork, leadership and followership, negotiation, and conflict resolution, mentoring and more. Whilst educators can attend workshops or courses to enhance their writing skills, there may be fewer opportunities to join a community of scholars and engage in successful collaborative writing. There is very little guidance on how to find, join, position oneself and contribute to a writing group. Once individuals join a group, further questions arise as to how to contribute, when and whom to ask for help, whether their contribution is significant, and how to move from the periphery to the centre of the group. The most important question of all is how to translate disparate ideas into a shared key message and articulate it clearly. In this guide, we describe the value of working within a collaborative writing group; reflect on principles that anchor the concept of writing as a team and guide team behaviours; suggest explicit strategies to overcome challenges and promote successful writing that contributes to and advances the field; and review challenges to starting, maintaining, and completing writing tasks. We approach writing through three lenses: that of the individual writer, the writing team, and the scholarly product, the ultimate goal being meaningful contributions to the field of Health Professions Education.

Supporting a teacher identity in health professions education: AMEE Guide No. 132.

This guide provides an understanding of what teacher identity is and how it can be developed and supported. Developing a strong teacher identity in the context of health professions education is challenging, because teachers combine multiple roles and the environment usually is more supportive to the identity of health practitioner or researcher than to that of teacher. This causes tensions for those with a teaching role. However, a strong teacher identity is important because it enhances teachers' intention to stay in health professions education, their willingness to invest in faculty development, and their enjoyment of the teaching role. The guide offers recommendations on how to establish workplace environments that support teacher identity rather than marginalise it. Additionally, the guide offers recommendations for establishing faculty development approaches that are sensitive to teacher identity issues. Finally, the guide provides suggestions for individual teachers in relation to what they can do themselves to nurture it.

Twelve tips for developing a global community of scholars in health professions education.

Scholarship in Health Professions Education is not just original research, it also includes study of educational processes, and application of new knowledge to practice. The pathways to successful scholarship are not always clear to novice educators. In this article, we describe strategies to establish a Community of Scholars (CoS), where more experienced and senior members guide junior members in scholarship to advance the field. Drawing on Lave and Wenger's concepts of Communities of Practice (CoP), we describe twelve practical tips, which include generation of a shared vision, formation of a global community of scholars, engagement in scholarly initiatives, and development of a professional identity, categorised under three major steps: establish, grow, and sustain the community. The tips embrace inclusivity for diverse cultural contexts which further provide opportunities for Health Professions Educators, interested in forming communities of practice, to work on scholarly outputs and add value to the professional arena.

Twelve tips for organising speed mentoring events for healthcare professionals at small or large-scale venues.

Mentors play a critical role in the development of professionals, influencing their job satisfaction, career aspirations and evolving professional identity. A variety of mentoring models exist, each with distinct benefits and challenges. Speed mentoring, based on the concept of speed dating, provides mentees with opportunities to meet multiple mentors over a short time and pose focussed career development questions. At large-scale events such as the annual AMEE (Association for Medical Education in Europe) meeting, speed mentoring sessions can successfully connect aspiring, novice and mid-career educators with international educational leaders to facilitate transfer of valuable insights for professional growth. For some mentors and mentees, this might spur ongoing communications or even longitudinal relationships. In this paper, we aim to provide strategies for planning and implementing speed mentoring events, combining insights gained from the literature and our experience of organising speed mentoring at the 2019 AMEE meeting in Vienna. These tips will be useful to a variety of professionals planning to organise speed mentoring initiatives.

Diversity training for medical students: evaluating impact.

Diversity training is an important component of medical training in helping prepare learners to manage an increasingly diverse patient population. This work (conducted as part of a medical student project) evaluated Year 3 medical student views and perceived learning following participation in a one-day diversity-focussed teaching day at a UK medical school. Post-session evaluation data was analysed alongside data obtained from a focus group of student participants. Students largely valued specific teaching on this area of professional development and appreciated the safe learning environment in which they could freely share their beliefs and values in relation to potential sensitive issues. There was however suggestions made that longitudinal curricular integration would be a preferable and this delivery model has now been adopted at this institution.

Very rapid flow cytometric assessment of antimicrobial susceptibility during the apparent lag phase of microbial (re)growth.

Rapid changes in the number and flow cytometric behaviour of cells of E. coli taken from a stationary phase and inoculated into rich medium.Cells of E. coli were grown in LB medium, taken from a stationary phase of 2-4 h, and re-inoculated into fresh media at a concentration (105 ml-1 or lower) characteristic of bacteriuria. Flow cytometry was used to assess how quickly we could detect changes in cell size, number, membrane energization (using a carbocyanine dye) and DNA distribution. It transpired that while the lag phase observable macroscopically via bulk OD measurements could be as long as 4 h, the true lag phase could be less than 15-20 min, and was accompanied by many observable biochemical changes. Antibiotics to which the cells were sensitive affected these changes within 20 min of re-inoculation, providing the possibility of a very rapid antibiotic susceptibility test on a timescale compatible with a visit to a GP clinic. The strategy was applied successfully to genuine potential urinary tract infection (UTI) samples taken from a doctor's surgery. The methods developed could prove of considerable value in ensuring the correct prescription and thereby lowering the spread of antimicrobial resistance.

Assessing Clinical Reasoning: Targeting the Higher Levels of the Pyramid.

Clinical reasoning is a core component of clinical competency that is used in all patient encounters from simple to complex presentations. It involves synthesis of myriad clinical and investigative data, to generate and prioritize an appropriate differential diagnosis and inform safe and targeted management plans.The literature is rich with proposed methods to teach this critical skill to trainees of all levels. Yet, ensuring that reasoning ability is appropriately assessed across the spectrum of knowledge acquisition to workplace-based clinical performance can be challenging.In this perspective, we first introduce the concepts of illness scripts and dual-process theory that describe the roles of analytic system 1 and non-analytic system 2 reasoning in clinical decision making. Thereafter, we draw upon existing evidence and expert opinion to review a range of methods that allow for effective assessment of clinical reasoning, contextualized within Miller's pyramid of learner assessment. Key assessment strategies that allow teachers to evaluate their learners' clinical reasoning ability are described from the level of knowledge acquisition, through to real-world demonstration in the clinical workplace.

Correction to: Assessing Clinical Reasoning: Targeting the Higher Levels of the Pyramid.

In this perspective, we first introduce the concepts of illness scripts and dual-process theory that describe the roles of non-analytic system 1 and analytic system 2 reasoning in clinical decision making.

Barriers to involving GP Speciality Trainees in the teaching of medical students in primary care: the GP trainer perspective.

Involvement in teaching activities is a curriculum requirement for GP Speciality Trainees (GPSTs). There are numerous potential benefits to involving GPSTs in teaching, including mutual educational benefit for both GPST and learner. However, GPSTs on placement in primary care may be less involved in teaching activities than hospital-based trainees. The reasons for this are not fully understood. This multi-site study aimed to explore the perceptions of GP trainers of the barriers to involving GPSTs in teaching in primary care. Focus groups of General Practice (GP) trainers from four regional GP training programmes across Northern England were conducted. Data were analysed thematically. Trainers cited barriers relating to the trainee (e.g. capacity and capability), practice (e.g. capacity), and teaching (e.g. appropriateness of teaching methods). Underlying these barriers, there appeared to be a cultural attitude towards GPST involvement in teaching: trainers viewed teaching as an extraneous rather than integral part of GP training, considered teaching to represent a deviation from the norm and felt that the GPST was restricted to a learner role. Whilst attempts to address the practical barriers identified in this study are required, a cultural shift in which the role of the GPST as a teacher becomes normalised is urgently needed.

Near peer teaching in general practice: option or expectation?

General Practice (GP) trainees who teach medical students do so as near peers with established educational benefits for all concerned. Through teaching, GP trainees consolidate their own knowledge and skills whilst students value the experience of learning from teachers closer in age and stage. Importantly, involving GP trainees as teachers increases primary care teaching capacity and promotes GP as a potential career option for undergraduates. However, whilst junior doctors are often to be found teaching on hospital wards and in clinics, GP trainees based in primary care appear to have fewer opportunities to teach. This article encourages the promotion of near peer teaching in primary care on several levels. We make practical suggestions of potential benefit to the individual GP trainee, trainer and practice. We also discuss ways in which key stakeholders, including medical schools and those organising post-graduate primary care training programmes, may promote near peer teaching in GP. We propose that all medical students should have experience of being taught by GP trainees, and that all future general practitioners should have training and experience of teaching undergraduate medical students.

Residents as teachers: Near peer learning in clinical work settings: AMEE Guide No. 106.

This AMEE Guide provides a framework to guide medical educators engaged in the design and implementation of "Resident as Teacher" programs. The suggested approaches are based on established models of program development: the Program Logic model to guide program design, the Dundee three-circle model to inform a systematic approach to planning educational content and the Kirkpatrick pyramid, which forms the backbone of program evaluation. The Guide provides an overview of Resident as Teacher curricula, their benefits and impact, from existing literature supplemented by insights from the authors' own experiences, all of whom are engaged in teaching initiatives at their own institutions. A conceptual description of the Program Logic model is provided, a model that highlights an outcomes-based curricular design. Examples of activities under each step of this model are described, which would allow educational leaders to structure their own program based on the scope, context, institutional needs and resources available. Emphasis is placed on a modular curricular format to not only enhance the teaching skills of residents, but also enable development of future career educators, scholars and leaders. Application of the Dundee three-circle model is illustrated to allow for a flexible curricular design that can cater to varying levels of educational needs and interests. In addition, practical advice is provided on robust assessment of outcomes, both assessment of participants and program evaluation. Finally, the authors highlight the need for congruence between the formal and hidden curriculum through explicit recognition of the value of teaching by institutions, support for development of teaching programs, encouragement of evidence-based approach to education and rewards for all levels of teachers.

Teaching empathy to medical students.

BACKGROUND: Empathy is a core skill essential to patient-centred care. Yet a decline in empathy throughout undergraduate medical education is well recognised. The mainstay of existing teaching approaches to foster medical students' empathic ability has largely focused on the cognitive domain of empathy within the context of communication skills learning. However, there is growing evidence for educational initiatives that better evoke students' affective emotional responses. APPROACH: A student-led educational initiative was created to enhance medical students' understanding of empathy through undertaking different experiential approaches. Eight medical students were invited to participate in an empathy workshop that involved two experiential approaches: personal simulation, and patient narrative, selected given their expected focus on the affective domain. EVALUATION: A subsequent focus group discussion explored students' reactions, learning, and intended future change in practice. Discussions were coded and analysed for descriptive themes. Both initiatives were reported to generate students' empathic responses. Personal simulation evoked more affective domains whilst patient narratives additionally created cognitive empathic insight into the impact of the patient's condition. Students also reported intended changes to their future consulting practices. CONCLUSIONS: Although this is a small-scale exploration of medical students' experiences of empathy-related teaching initiatives, it offers insight into how each initiative could target different aspects of empathy. Data support the use of even brief experiential teaching to improve medical students' empathy during their undergraduate training. We provide recommendations for clinical educators who are considering designing similar initiatives within their undergraduate medical curricula.