Live streaming to sustain clinical learning.

BACKGROUND: The COVID-19 pandemic has necessitated the need to develop teaching innovations that provide safe, authentic clinical encounters which facilitate experiential learning. In tandem with the dissemination of teleconsultation and online teaching, this pilot study describes, evaluates and justifies a multi-camera live-streaming teaching session to medical students from the clinical environment. APPROACH: Multiple audio and video inputs capturing an outpatient clinic setting were routed through Open Broadcast Software (OBS) to create a customised feed streamed to remote learners through a videoconferencing platform. Sessions were conducted between September 2020 and March 2021. Twelve students sequentially interacted with a patient who held an iPad. Higher quality Go-Pro cameras captured the scene, allowing students to view the consultation from the patient and doctor's perspective. A consultant then conducted a 'gold standard' patient consultation observed by students. A faculty member remotely facilitated the session, providing pre-clinic teaching and debriefing. The equipment required with costing for a standard and low-cost version is described, as well as a set-up schematic and overview of ideal conditions and barriers encountered during trials. EVALUATION: All students completed a post-participation questionnaire, rating the overall quality of the sessions as 9.7/10. The quality of online facilitation, utility of observing peers' and consultant interaction with the patient, opportunity for peer-to-peer learning and availability of multiple camera angles were particularly valued by students. IMPLICATIONS: This innovation permits an authentic clinical interaction to be experienced by multiple students remotely, promoting equitable access to high-quality teaching, while maintaining the safety of students and patients.

Peer teacher training (PTT) in action.

BACKGROUND: The benefits of peer teaching for tutors, students and institutions are well documented. Skills in peer teaching, assessment and feedback are cited as important graduate attributes by international medical councils; however, the literature on preparation for this role, specifically peer teacher training (PTT), is sparse. This study evaluated the implementation of a PTT programme adopted from the Medical School at the University of Sydney in 2016. The programme was adopted to support the development of skills in UK medical undergraduates. The training was accessed by students studying at the University of Leicester in 2017 and 2018. METHODS: The course was evaluated using mixed methods. Students completed pre- and post-course self-rated questionnaires. Semi-structured focus groups were conducted after each course to investigate students' perceptions. RESULTS: Twenty fourth-year medical students attended the PTT. Students reported improvements in their understanding of educational principles, confidence in teaching and feedback skills, and an increased likelihood of volunteering to teach. Focus groups revealed potential benefits for future patient interaction and preparation for educator roles. DISCUSSION: The PTT provided an effective approach for medical students to gain perceived competence and confidence in teaching and giving feedback. Students reported an increased propensity for teaching when qualified. Students with lower self-reported teaching ability reported greater improvements following the course. Students reported unanticipated perceived benefits for improving patient education and obtaining teaching accreditation for their portfolio and future clinical roles. They perceived potential value if the training were to be made interprofessional on future courses. Furthermore, this study demonstrates the transferability of the PTT programme across university settings.

Exploring junior doctor morale in a UK hospital.

BACKGROUND: The importance of junior doctor morale is increasingly being recognised. We aimed to identify and explore the factors affecting junior doctor morale in a UK teaching hospital. METHODS: We carried out an online survey asking junior doctors to rate their morale, rank the top five factors that positively affected morale and offer free-text comments. RESULTS: Nine hundred and forty three junior doctors were approached, 402 (42.6%) responded. Overall morale was rated 6 [interquartile range (IQR): 5-8], and how valued 6 (IQR: 4-8), supported 7 (IQR: 6-9) and autonomous 7 (IQR: 6-8) they felt [median ratings using a scale of 0 (low)-10 (high)]. When comparing the four domains of feeling supported, feeling valued, having autonomy and overall morale, respondents felt most supported overall (n = 402, χ2 = 85.6, p < 0.0001). Key themes were identified: team working and relationships, feedback, training and education, resources, wellbeing and pastoral support, staffing and workload, senior clinician support, and autonomy. The most common factors positively affecting morale were 'feeling part of a team' (66.4%) and 'being recognised for good practice' (56.7%). CONCLUSION: We identified a number of diverse themes affecting junior doctor morale. Doctors felt more supported than valued or autonomous, with complex relationships between these domains.

Education quality for future doctors: a case study of the introduction of an Education Quality Dashboard (EQD) in a UK teaching hospital.

BACKGROUND: The quality of postgraduate training environments vary, but measures of the quality of training environments are lacking. This case study describes the use of management principles combined with educational expertise to facilitate the development and evaluation of an Education Quality Dashboard (EQD) for monitoring the quality of training in a large UK NHS teaching hospital. METHODS: Evaluation was conducted through the inspection of data-reporting trends and interviews with key stakeholders. Fourteen key stakeholders took part in semi-structured interviews about their experiences of implementing the EQD. Data were analysed thematically using nvivo 10. RESULTS: The introduction of the EQD drove improvements in completeness of data about education standards, and improvements in performance on key metrics. Interviewees suggested that the EQD was feasible to compile but required infrastructure for data collection to be established and maintained. The use of a dashboard format was seen as helping to raise the profile of education quality standards in the trust, particularly at the board level, although some limitations of the dashboard were noted. The EQD enabled proactive monitoring and managing of problems with the educational environment, and interviewees identified concrete improvements that had resulted from the use of the dashboard. Making the EQD work well required commitment and leadership from senior staff. Feeding back and acting on findings was seen as critical for continuing engagement. DISCUSSION: The dashboard is now embedded as part of routine practice across the hospital, and has the potential to be implemented nationally to help drive improvements in the quality of education provision.