Development and impact of a massive open online course (MOOC) for antimicrobial stewardship.

Background: The University of Dundee and the BSAC developed a massive open online course (MOOC) to address the global need for education to support antimicrobial stewardship in low- and middle-income countries. Methods: An interactive course, Antimicrobial Stewardship: Managing Antibiotic Resistance, was developed and delivered via the FutureLearn© platform. The course ran over four 6 week periods during 2015 and 2016 supported by educators and was evaluated via data on uptake and feedback from learners on impact on clinical practice. Results: In total, 32 944 people, 70% of them healthcare professionals, from 163 countries joined the course from Europe (49%), Asia (16%), Africa (13%), North America (9%), Australia (8%) and South America (5%). Between 33% and 37% of joiners in each run completed at least one step in any week of the course and 219 participants responded to a post-course survey. The course was rated good or excellent by 208 (95%) of the participants, and 83 (38%) intended to implement stewardship interventions in their own setting. A follow-up survey 6 months later suggested that 49% had implemented such interventions. Conclusions: The MOOC has addressed a global learning need by providing education free at the point of access, and learning from its development will help others embarking upon similar educational solutions. Initial quantitative and qualitative feedback suggests it has engaged participants and complements traditional educational methods. Measuring its real impact on clinical practice remains a challenge. The FutureLearn© platform offers flexibility for MOOCs to be sustainable through modification to remove educator facilitation but maintain active participant discussion.

A Prospective Analysis of Screen-Detected Cancers Recalled and Not Recalled by Artificial Intelligence.

OBJECTIVE: The use of artificial intelligence has potential in assisting many aspects of imaging interpretation. We undertook a prospective service evaluation from March to October 2022 of Mammography Intelligent Assessment (MIA) operating "silently" within our Breast Screening Service, with a view to establishing its performance in the local population and setting. This evaluation addressed the performance of standalone MIA vs conventional double human reading of mammograms. METHODS: MIA analyzed 8779 screening events over an 8-month period. The MIA outcome did not influence the decisions made on the clinical pathway. Cases were reviewed approximately 6 weeks after the screen reading decision when human reading and/or MIA indicated a recall. RESULTS: There were 146 women with positive concordance between human reading and MIA (human reader and MIA recalled) in whom 58 breast cancers were detected. There were 270 women with negative discordance (MIA no recall, human reader recall) for whom 19 breast cancers and 1 breast lymphoma were detected, with 1 cancer being an incidental finding at assessment. Six hundred and four women had positive discordance (MIA recall, human reader no recall) in whom 2 breast cancers were detected at review. The breast cancers demonstrated a wide spectrum of mammographic features, sites, sizes, and pathologies, with no statistically significant difference in features between the negative discordant and positive concordant cases. CONCLUSION: Of 79 breast cancers identified by human readers, 18 were not identified by MIA, and these had no specific features or site to suggest a systematic error for MIA analysis of 2D screening mammograms.

How we encourage faculty development.

Most clinicians enjoy teaching medical students, but many have had little training as clinical teachers. The General Medical Council (GMC) in 'Good Medical Practice' states 'if you are involved in teaching you must develop the skills, attitudes and practices of a competent teacher' (GMC 2006). Mclean et al.'s (2008) AMEE guide on faculty development outlines practice points for those responsible for developing their faculty's educational skills. In this article, we look at one health region, Tayside in East Scotland, where the University of Dundee, NHS Education for Scotland (NES) and NHS Tayside are collaborating to implement these practice points. This combined approach has proved to be effective in progressing staff development and recruiting additional clinical colleagues to develop their teaching role.

General practitioners with a special interest in public health; at last a way to deliver public health in primary care.

Primary care and public health both work to improve the population's health. The potential benefits of improved integration between these disciplines have however not been fully seen because of the lack of a structured way to deliver the integration. This article reviews the benefits, models of working, and challenges to the integration of public health and primary care. General practitioners with special interests (GPwSI) have now been created and formally recognised in clinical roles in the United Kingdom. It is proposed that the creation of GPwSI in public health offers an ideal model of a way of achieving integration and ensuring public health is delivered in primary care.

Child and Adolescent Mental Health Interface Work with Primary Services: A Survey of NHS Provider Trusts.

BACKGROUND: We document the extent, nature and predictors of interface work between secondary Child and Adolescent Mental Health (CAMHS) and primary services, through structured questionnaires sent to all Trusts with CAMHS in England (returned by 124/150 or 83%). RESULTS: Two-thirds of CAMHS reported training and education to primary care services, about one-third a structured consultation service, one-fifth reported undertaking outpatient clinics in primary care settings and joint casework. One-third had developed primary mental health worker posts. Multiple regression analysis identified firstly specialist clinics within CAMHS, and secondly CAMHS size, as the strongest predictors of interface work across agencies. Interface work thus grows with more developed, larger CAMHS.

Primary mental health workers in child and adolescent mental health services.

BACKGROUND: The interface between primary care and specialist services is increasingly seen as crucial in the effective management of child and adolescent mental health (CAMH) problems. In the United Kingdom, a new role of primary mental health worker (PMHW), has been established in order to achieve effective collaboration across the interface through the provision of clinical care in primary care settings and by improving the skills and confidence of primary care staff. However, little is known about the development of this innovative role in service contexts. Issues raised during the early stages of implementation may have important implications for the preparation and development of professionals who undertake the role. AIMS: The aim of this paper is to report on a study that examined key issues in implementation of the PMHW role in six health authorities in England. METHODS: Case study evaluation was conducted, using thematic analysis of 75 qualitative interviews with key stakeholders from different professions (e.g. PMHWs, general practitioners, health visitors, psychiatrists and service managers) and representing different sectors (primary care, specialist services and community child health services). FINDINGS: The study identified three models of organization (outreach, primary care-based and teams). Each was associated with different advantages and disadvantages in its effects on referral rates to specialist services and the development of effective working relationships with primary care providers. Problems associated with accommodation and effective integration of PMHWs with specialist services, and tensions caused by the two different roles that PMHWs could undertake (direct clinical care vs. consultation-liaison) were common across all sites. CONCLUSIONS: The PMHW role is an important development that may go some way towards realizing the potential of primary care services in CAMH. The implementation of new roles and models of working in primary care is complex, but may be facilitated by effective planning with primary care providers, clear goals for staff, and a long-term perspective on service development.