A qualitative evaluation of the impact of a medical student school outreach project on both medical students and school pupils.

OBJECTIVE: To explore medical student and school pupil experiences of an outreach school teaching project. SETTING: Community engagement is increasingly commonplace within medical school. Secondary schools offer ample opportunities for community engagement as medical students teach and engage in service learning. There is a lack of research regarding the impact of school community engagement projects and the impact on pupils, as critical stakeholders in the service medical students provide. In this qualitative study, we explore the perspectives of medical students and school pupils involved in a school teaching project. PARTICIPANTS: Ten medical students participated in individual interviews, and 17 school pupils across three schools participated in group interviews. Data were analysed using thematic analysis and the concept of service learning. RESULTS: For medical students, the project fostered communication and teaching skills, but a lack of reflection hampered further benefit. For school pupils, experiences varied - learning about careers in medicine could be inspiring, but content pitched at the incorrect level disengaged some pupils. The conflict between session timing and medical students' exams negatively influenced engagement. CONCLUSIONS: To shift the focus of community engagement projects that promote service-learning towards mutual benefit, designing in partnership with relevant community stakeholders and integrating opportunities to reflect on these experiences are critical.

Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students' longitudinal experiences in primary care.

OBJECTIVE: Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school. DESIGN: We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis. SETTING: One research-intensive medical school based in the UK. Data collection occurred in 2021-2022. PARTICIPANTS: 12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year. RESULTS: We constructed four themes capturing insights on how hidden curricula influenced students' experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning. CONCLUSIONS: The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.

' And how did that make you feel?' - GP trainees' perceptions of Balint on a local UK vocational training scheme.

Balint allows colleagues to explore emotions generated from doctor-patient interactions, complexities sometimes overlooked within traditional curricula. With an increasing burnout rate, evidence-based strategies to support trainee general practitioners (GPs) are needed and we investigated if Balint could be one way to improve this. There are no recent studies looking at Balint in UK GP training. Our aim was to establish GP trainees' understanding of the purpose of Balint and perceived advantages and disadvantages. Qualitative methodology was used to conduct semi-structured interviews with trainees and alumni participating in Balint within a suburban London Vocational Training Scheme. Emergent coding was performed and a phenomenological approach taken to thematic analysis. Eleven participants took part in the study. Balint provided a supportive, confidential outlet to help normalise trainees' feelings after challenging doctor-patient interactions. Multiple viewpoints, the chance to vent and a sense of comradery was unanimously enjoyed. Participants could see potential benefits for delivery of care, patient safety and remaining up-to-date. There was debate over inclusion of clinical management, and variation in preferred facilitation styles. Disparity in Balint contribution was attributed to differing personalities and confidence levels. With the growing demands of general practice, a flexible approach to Balint facilitation could add value in training by providing a peer platform to help address the hidden curriculum.

Multiple extra-synaptic spillover mechanisms regulate prolonged activity in cerebellar Golgi cell-granule cell loops.

Despite a wealth of in vitro and modelling studies it remains unclear how neuronal populations in the cerebellum interact in vivo. We address the issue of how the cerebellar input layer processes sensory information, with particular focus on the granule cells (input relays) and their counterpart inhibitory interneurones, Golgi cells. Based on the textbook view, granule cells excite Golgi cells via glutamate forming a negative feedback loop. However, Golgi cells express inhibitory mGluR2 receptors suggesting an inhibitory role for glutamate. We set out to test this glutamatergic paradox in Golgi cells. Here we show that granule cells and Golgi cells interact through extra-synaptic signalling mechanisms during sensory information processing, as well as synaptic mechanisms. We demonstrate that such interactions depend on granule cell-derived glutamate acting via inhibitory mGluR2 receptors leading causally to the suppression of Golgi cell activity for several hundreds of milliseconds. We further show that granule cell-derived inhibition of Golgi cell activity is regulated by GABA-dependent extra-synaptic Golgi cell inhibition of granule cells, identifying a regulatory loop in which glutamate and GABA may be critical regulators of Golgi cell­granule cell functional activity. Thus, granule cells may promote their own prolonged activity via paradoxical feed-forward inhibition of Golgi cells, thereby enabling information processing over long timescales.