What guides student learning in the clinical years: A mixed methods study exploring study behaviours prior to the UK Medical Licensing Assessment (UKMLA).

PURPOSE: Student study behaviours that prioritise the UKMLA content map over the local curriculum are a significant risk for UK medical education. To mitigate this, we describe a student-centred faculty process to improve local curriculum guidance based on an evaluation of student study behaviours, concerns and needs. Responses informed the build of an online curriculum map. METHODS: A mixed methods approach was adopted, including an online anonymous survey exploring student study behaviours and preferences for curricular guidance. This was followed by student-led focus groups to explore emergent themes further. Qualitative data underwent reflexive thematic analysis. RESULTS: 121 students responded to the survey, of which 12 consented to participate in two student-led focus groups. Five key themes emerged, including motivation for learning, student use of the intended curriculum, student experience of the enacted curriculum, the hidden curriculum, and expectations of an online curriculum map. CONCLUSIONS: A participatory framework enabled shared aims and responsive outcomes for curricular development in the run up to the UKMLA. Student responses led to clarification of guidance, reorganisation of learning resources and optimal design of an online curriculum map which linked all content in a visible, UKMLA aligned framework, accessible to all students and teachers.

Humanising case-based learning.

PURPOSE OF THE ARTICLE: Medical undergraduates at St George's, University of London (SGUL) study a weekly clinical case during their clinical science years. Audit of the human stories demonstrated lack of diversity, mono-professionalism, and objectification of some patients. A collaborative partnership with staff, student and patient representation implemented curriculum change, including an inclusive case-writing initiative. We explored whether the reformed written cases supported the development of positive attitudes by sampling perceptions of the cases amongst students. METHODS: Sixteen semi-structured interviews were conducted (Feb-November 2022) with first year medical students. We applied an interpretative phenomenological analysis approach. Verbatim transcripts were coded and analysed to elucidate themes. RESULTS: Four themes were identified: (i) effective learning, (ii) clinical authenticity, (iii) authentic human stories, and (iv) opportunity for rehearsing the role of a doctor. Students perceived the cases as an effective, contextual learning method, with a high degree of clinical authenticity, allowing mentalisation of doctor attitudes and behaviours in relation to patient-centredness, multidisciplinary team working and diversity. CONCLUSION: The results suggest the reformed cases created positive attitudinal change amongst students and supported transition to clinical roles. Memorable human stories had the greatest impact. Dynamic, inclusive, and collaborative case writing initiatives which integrate realism, diversity and multi-professionalism may help to foster positive experiences in students undertaking CBL sessions.

Primary care in the world of integrated care systems: education and training for general practice.

Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.

Facilitators and barriers to COVID-19 vaccination uptake among ethnic minorities: A qualitative study in primary care.

INTRODUCTION: COVID-19 vaccination effectively reduces severe disease and death from COVID-19. However, both vaccine uptake and intention to vaccinate differ amongst population groups. Vaccine hesitancy is highest amongst specific ethnic minority groups. There is very limited understanding of the barriers and facilitators to COVID-19 vaccine uptake in Black and South Asian ethnicities. Therefore, we aimed to explore COVID-19 vaccination hesitancy in primary care patients from South Asian (Bangladeshi/Pakistani) and Black or Black British/African/Caribbean/Mixed ethnicities. METHODS: Patients from the above ethnicities were recruited using convenience sampling in four London general practices. Telephone interviews were conducted, using an interpreter if necessary, covering questions on the degree of vaccine hesitancy, barriers and potential facilitators, and decision-making. Interviews were transcribed verbatim and thematically analysed. Data collection and analysis occurred concurrently with the iterative development of the topic guide and coding framework. Key themes were conceptualised through discussion with the wider team. RESULTS: Of thirty-eight interviews, 55% (21) of these were in Black or Black British/African/Caribbean/Mixed ethnicities, 32% (12) in Asian / British Asian and 13% (5) in mixed Black and White ethnicities. Key themes included concerns about the speed of vaccine roll-out and potential impacts on health, mistrust of official information, and exposure to misinformation. In addition, exposure to negative messages linked to vaccination appears to outweigh positive messages received. Facilitators included the opportunity to discuss concerns with a healthcare professional, utilising social influences via communities and highlighting incentives. CONCLUSION: COVID-19 has disproportionately impacted ethnic minority groups. Vaccination is an effective strategy for mitigating risk. We have demonstrated factors contributing to vaccine reluctance, hesitancy and refusal and highlighted levers for change.

Undergraduate medical teaching with remote consultations in general practice: a realist evaluation.

BACKGROUND: Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM: To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact. DESIGN & SETTING: A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK. METHOD: An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS: The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care. CONCLUSION: Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.

Patients' Experiences of "Long COVID" in the Community and Recommendations for Improving Services: A Quality Improvement Survey.

INTRODUCTION: "Long COVID" is a multisystem disease that lasts for 4 or more weeks following initial symptoms of COVID-19. In the UK, at least 10% of patient report symptoms at 12 weeks following a positive COVID-19 test. The aims of this quality improvement survey were to explore patients' acute and post-acute "long" COVID-19 symptoms, their experiences of community services and their recommendations for improving these services. METHODS: Seventy patients diagnosed with COVID were randomly selected from 2 large socially and ethnically diverse primary care practices. Of those contactable by telephone, 85% (41/48) agreed to participate in the quality improvement survey. They were interviewed by telephone using a semi-structured questionnaire about community services for COVID-19 patients. Interviews lasted 10 to 15 minutes. RESULTS: Forty-nine percent of patients reported at least 1 post-acute COVID-19 symptom. The most common were severe fatigue (45%), breathlessness (30%), neurocognitive difficulties (such as poor memory), poor concentration and "brain fog" (30%), headaches (20%), and joint pain (20%). Many patients felt isolated and fearful, with scant information about community resources and little safety netting advice. Patients also expected more from primary care with over half (56%) recommending regular phone calls and follow up from healthcare staff as the most important approach in their recovery. CONCLUSIONS: In line with patients' requests for more support, the practices now routinely refer patients with long COVID to an on-site social prescriber who explores how they are getting on, refers them to the GP or practice nurse when required, and sign posts them to support services in the community.

Strategy for the creation of clinical grade hESC line banks that HLA-match a target population.

Here, we describe a pre-derivation embryo haplotyping strategy that we developed in order to maximize the efficiency and minimize the costs of establishing banks of clinical grade hESC lines in which human leukocyte antigen (HLA) haplotypes match a significant proportion of the population. Using whole genome amplification followed by medium resolution HLA typing using PCR amplification with sequence-specific primers (PCR-SSP), we have typed the parents, embryos and hESC lines from three families as well as our eight clinical grade hESC lines and shown that this technical approach is rapid, reliable and accurate. By employing this pre-derivation strategy where, based on HLA match, embryos are selected for a GMP route on day 3-4 of development, we would have drastically reduced our cGMP laboratory running costs.