Embedding Assessment Literacy Can Enhance Graduate Attribute Development in a Biomedical Sciences Curriculum.

This paper describes the successful implementation of an assessment literacy strategy within a Biomedical Sciences degree. Teaching was aligned with an assessment literacy framework and aimed to prepare undergraduates for a literature comprehension assessment. Students were introduced to the assessment purpose and an adapted Miller's pyramid model illustrated how the assessment contributed to competency development during their degree. Students read primary research papers and answered questions relating to the publications. They were then introduced to the processes of assessment and collaboratively graded answers of different standards. Finally, student and faculty grades were compared, differences considered, and key characteristics of answers discussed. Most students reported that they understood more about assessment standards than prior to the intervention [139/159 (87.4%)] and felt it had helped prepare them for their exam [138/159 (86.8%)]. The majority also reported they had increased confidence in evaluating data [118/159 (74%)], communicating their reasoning [113/159 (71%)] and considering what a reader needs to know [127/159 (79.9%)]. Students were asked to state the most important thing they had learned from the assessment literacy teaching. Notably, no responses referred to domain-specific knowledge. 129 free text responses were mapped to the University of Edinburgh graduate attribute framework. 93 (72%) statements mapped to the graduate attribute category "Research and Enquiry," 66 (51.16%) mapped to "Communication" and 21 (16.27%) mapped to "Personal and Intellectual Autonomy." To explore any longer-term impact of the assessment literacy teaching, a focus group was held with students from the same cohort, 2 years after the original intervention. Themes from this part of the study included that teaching had provided insights into standards and expectations for the assessment and the benefits of domain specific knowledge. A variety of aspects related to graduate attributes were also identified. Here, assessment literacy as a vehicle for graduate attribute development was an unexpected outcome. We propose that by explicitly engaging students with purpose, process, standards, and expectations, assessment literacy strategies may be used to successfully raise awareness of developmental progression, and enhance skills, aptitudes, and dispositions beneficial to Biomedical Sciences academic achievement and life after university.

Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options?

BACKGROUND: Midwife-led birth centres (MLBCs) are associated with reduced childbirth interventions, higher satisfaction rates, and improved birth outcomes. The evidence on quality of care in MLBCs from low and middle-income countries (LMIC) is limited. AIM: This study aimed to explore the perceptions of women and midwives regarding the quality of care in four MLBCs in Uganda. METHODS: A qualitative study was conducted in four MLBCs in Uganda. We conducted interviews with women and midwives in the MLBCs to explore their perceptions and experiences related to care in the MLBCs. The study obtained ethical approval. Deductive thematic analysis was used for data analysis. RESULTS: Three key themes were identified regarding the perceptions of women and midwives about the quality of care in the MLBCs: providing respectful, and dignified care; a focus on woman-centred care; and reasons for choosing care in the MLBC. Women valued the respectful and humane care characterised by dignified and non-discriminatory care, non-abandonment, privacy, and consented care. The woman-centred care in the MLBC involved individualised holistic care, providing autonomy and empowerment, continuity of care, promoting positive birth experience, confidence in the woman's own abilities, and responsive providers. Women chose MLBCs because the services were perceived to be available, accessible, affordable, with comprehensive and effective referral mechanisms. CONCLUSION: Women perceived care to be respectful, woman-centred, and of good quality. Global attention should be directed to scaling up the establishment of MLBCs, especially in LMIC, to improve the positive childbirth experience and increase access to care.

Multiprofessional heart failure self-development framework.

OBJECTIVE: Heart failure remains a key public health priority across the globe. The median age of people with heart failure admitted to hospital in the UK is 81 years old. Many such patients transcend the standard interventions that are well characterised and evidenced in guidelines, into holistic aspects surrounding frailty, rehabilitation and social care. Previous published competency frameworks in heart failure have focused on the value of doctors, nurses and pharmacists. We aimed to provide an expert consensus on the minimum heart failure-specific competencies necessary for multiple different healthcare professionals, including physiotherapists, occupational therapists, dietitians and cardiac physiologists. METHODS: The document has been developed focussing on four main parts, (1) establishing a project working group of expert professionals, (2) a literature review of previously existing published curricula and competency frameworks, (3) consensus building, which included developing a structure to the framework with ongoing review of the contents to adapt and be inclusive for each specialty and (4) write up and dissemination to widen the impact of the project. RESULTS: The final competency framework displays competencies across seven sections; knowledge (including subheadings on heart failure syndrome, diagnosis and clinical management); general skills; heart failure-specific skills; clinical autonomy; multidisciplinary team working; teaching and education; and research and development. CONCLUSION: People with heart failure can be complex and have needs that require input from a broad range of specialties. This publication focuses on the vital impact of wider multidisciplinary groups and should help define the generic core heart failure-specific competencies needed to support future pipelines of professionals, who regularly interact with and deliver care for patients with heart failure.

Midwife-led birthing centres in four countries: a case study.

BACKGROUND: Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. METHODS: A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. RESULTS: Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. CONCLUSION: The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.

Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey.

Evidence about the safety and benefits of midwife-led care during childbirth has led to midwife-led settings being recommended for women with uncomplicated pregnancies. However, most of the research on this topic comes from high-income countries. Relatively little is known about the availability and characteristics of midwife-led birthing centres in low- and middle-income countries (LMICs). This study aimed to identify which LMICs have midwife-led birthing centres, and their main characteristics. The study was conducted in two parts: a scoping review of peer-reviewed and grey literature, and a scoping survey of professional midwives' associations and United Nations Population Fund country offices. We used nine academic databases and the Google search engine, to locate literature describing birthing centres in LMICs in which midwives or nurse-midwives were the lead care providers. The review included 101 items published between January 2012 and February 2022. The survey consisted of a structured online questionnaire, and responses were received from 77 of the world's 137 low- and middle-income countries. We found at least one piece of evidence indicating that midwife-led birthing centres existed in 57 low- and middle-income countries. The evidence was relatively strong for 24 of these countries, i.e. there was evidence from at least two of the three types of source (peer-reviewed literature, grey literature, and survey). Only 14 of them featured in the peer-reviewed literature. Low- and lower-middle-income countries were more likely than upper-middle-income countries to have midwife-led birthing centres. The most common type of midwife-led birthing centre was freestanding. Public-sector midwife-led birthing centres were more common in middle-income than in low-income countries. Some were staffed entirely by midwives and some by a multidisciplinary team. We identified challenges to the midwifery philosophy of care and to effective referral systems. The peer-reviewed literature does not provide a comprehensive picture of the locations and characteristics of midwife-led birthing centres in low- and middle-income countries. Many of our findings echo those from high-income countries, but some appear to be specific to some or all low- and middle-income countries. The study highlights knowledge gaps, including a lack of evidence about the impact and costs of midwife-led birthing centres in low- and middle-income countries.

Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review.

The evidence for the benefits of midwifery has grown over the past two decades and midwife-led birthing centres have been established in many countries. Midwife-led care can only make a sustained and large-scale contribution to improved maternal and newborn health outcomes if it is an integral part of the health care system but there are challenges to the establishment and operation of midwife-led birthing centres. A network of care (NOC) is a way of understanding the connections within a catchment area or region to ensure that service provision is effective and efficient. This review aims to evaluate whether a NOC framework-in light of the literature about midwife-led birthing centres-can be used to map the challenges, barriers and enablers with a focus on low-to-middle income countries. We searched nine academic databases and located 40 relevant studies published between January 2012 and February 2022. Information about the enablers and challenges to midwife-led birthing centres was mapped and analysed against a NOC framework. The analysis was based on the four domains of the NOC: 1) agreement and enabling environment, 2) operational standards, 3) quality, efficiency, and responsibility, 4) learning and adaptation, which together are thought to reflect the characteristics of an effective NOC.Of the 40 studies, half (n = 20) were from Brazil and South Africa. The others covered an additional 10 countries. The analysis showed that midwife-led birthing centres can provide high-quality care when the following NOC elements are in place: a positive policy environment, purposeful arrangements which ensure services are responsive to users' needs, an effective referral system to enable collaboration across different levels of health service and a competent workforce committed to a midwifery philosophy of care. Challenges to an effective NOC include lack of supportive policies, leadership, inter-facility and interprofessional collaboration and insufficient financing. The NOC framework can be a useful approach to identify the key areas of collaboration required for effective consultation and referral, to address the specific local needs of women and their families and identify areas for improvement in health services. The NOC framework could be used in the design and implementation of new midwife-led birthing centres.

Exploring Student Experiences of an Undergraduate Certificate in Veterinary Medical Education.

The ability to teach is recognized as a core skill for many professionals, including veterinarians, but undergraduate opportunities to develop this skill are not always available. A complementary teaching certificate offered during the clinical years of an undergraduate veterinary program was evaluated to investigate student experiences of the program and the perceived benefits and challenges of participating. The study used a mixed methods approach with questionnaires to provide an overview of the participant experience and semi-structured interviews to gain a deeper insight into students' experiences of the program. Two cohorts completed questionnaires comprising Likert-style and open-ended questions on the 3-year teaching certificate, the first cohort after 1 year of the program and the second cohort at completion. Interviews with participants from both cohorts were thematically analyzed to identify recurring themes. An average of 27% of students per academic year enrolled in the certificate program, most of whom completed it. Additionally, four to six students per cohort applied for Associate Fellow of the Higher Education Academy (AFHEA), and 19 students have achieved this recognition. Key themes from the data included that students felt the certificate built their confidence, increased their veterinary knowledge, and helped them become better teachers, with time management and reflection the biggest challenges. The Undergraduate Certificate of Veterinary Medical Education was seen as a good teaching foundation, while working toward the AFHEA provided some insight into higher education and academic careers. A structured teaching program offers students the opportunity to develop their learning and reflection both as students and future educators.

Development and Evaluation of a Faculty-Based Accredited Continuing Professional Development Route for Teaching and Learning.

This article characterizes and evaluates the development of an accredited, in-house, faculty-based teaching recognition scheme aimed at supporting clinicians and academics to achieve Advance HE Fellowship recognition. The scheme takes 6 to 24 months to complete and forms part of an institution-wide scheme. The evaluation covered 44 months, collecting data on participation rates across the school and 21 semi-structured interviews across 16 staff participants. We describe the outcomes measured alongside key perceived benefits and challenges to support the implementation of similar schemes elsewhere. Across 130 academic staff, there was 61% engagement. In interviews, 11 participants characterized benefits in terms of changes to their teaching, such as adopting new strategies for differing class sizes, and highlighted the benefit of accessible and context-specific development opportunities designed specifically for STEMM (science, technology, engineering, mathematics, and medicine) practitioners and clinicians. Motivations for participating were mainly intrinsic (69%), with international professional recognition also featured (61%, n = 10). Of the 23 participants who withdrew, the largest subgroup (39%) withdrew because they had left the institution, and 35% withdrew because of a lack of time, which encompassed a range of issues. We outline recommendations for implementing similar schemes including protected time, accessible development opportunities, and support for mentors.

Employability as a Guiding Outcome in Veterinary Education: Findings of the VetSet2Go Project.

This paper presents a mini-review of employability as a guiding outcome in veterinary education-its conceptualisation, utility, core elements and dimensions, and pedagogical approaches-through a summary of the findings of a major international project with the same aims (the VetSet2Go project). Guided by a conception of the successful veterinary professional as one capable of navigating and sustainably balancing the (sometimes competing) needs and expectations of multiple stakeholders, the project integrated multiple sources of evidence to derive an employability framework representing the dimensions and capabilities most important to veterinary professional success. This framework provides a useful complement to those based in narrower views of competency and professionalism. One notable difference is its added emphasis on broad success outcomes of satisfaction and sustainability as well as task-oriented efficacy, thus inserting "the self" as a major stakeholder and bringing attention to resilience and sustainable well-being. The framework contains 18 key capabilities consistently identified as important to employability in the veterinary context, aligned to five broad, overlapping domains: veterinary capabilities (task-oriented work performance), effective relationships (approaches to others), professional commitment (approaches to work and the broader professional "mission"), psychological resources (approaches to self), plus a central process of reflective self-awareness and identity formation. A summary of evidence supporting these is presented, as well as recommendations for situating, developing, and accessing these as learning outcomes within veterinary curricula. Though developed within the specific context of veterinarian transition-to-practise, this framework would be readily adaptable to other professions, particularly in other health disciplines.

A new consultation, Assessment and reflection model (CARM) used in child and adolescence mental health services (CAMHS).

UK National Guidelines stress the importance of reducing waiting times for mental health assessments and interventions for children. They stress the importance of early help, multidisciplinary working, and collaboration with families regarding treatment plans. We piloted a new assessment model (CARM) within a CAMHS service to: reduce non-attendance rates and subsequently waiting times; increase staff and patient satisfaction; and improve the quality of assessment. All waiting list patients and new referrals over a three-month period were contacted to self-book an hour session to meet two clinicians who utilised collaborative reflection and formulation to produce a care plan (CARM). Results revealed that non-attendance rates dropped from 33% over the month prior to CARM to 7% during CARM. Satisfaction levels were high. Qualitative feedback regarding satisfaction revealed the most common themes was feeling listened to and having the opportunity to listen to staff reflections. The themes of staff satisfaction included 'feeling more supported' and 'feeling safer in their decision making'. All assessments were completed in the one appointment. A formulation-driven care plan was developed and discussed with the family. This approach has the potential to make services more effective, efficient and satisfying for both staff and families.

Developing Miller's Pyramid to Support Students' Assessment Literacy.

Assessment literacy is increasingly recognized as an important concept to consider when developing assessment strategies for courses and programs. Assessment literacy approaches support students in their understanding of assessment expectations and help them both understand and optimize their performance in assessment. In this teaching tip, a model for assessment literacy that builds on the well-known Miller's Pyramid model for assessment in clinical disciplines is proposed and contextualized. The model progresses thinking from assessment methods themselves to consideration of the activities that need to be built into curricula to ensure that assessment literacy is addressed at each level of the pyramid. The teaching tip provides specific examples at each of the levels. Finally, the relevance of this work to overall curriculum design is emphasized.

'Care about my animal, know your stuff and take me seriously': United Kingdom and Australian clients' views on the capabilities most important in their veterinarians.

Success in veterinary practice requires careful balancing of stakeholder needs. The aim of this study was to investigate the current expectations and needs of veterinary clients across a range of practice types. Interviews and focus groups were undertaken with veterinary clients to identify the capabilities of veterinarians that result in the best client experience, generating a 'Veterinary Capability Framework'. This comprised six main capabilities each containing 4-10 behavioural indicators: client relationships; professionalism; communication skills; decision-making and problem solving; commitment to animal welfare; and commitment to quality and the profession. An online survey was then conducted to validate the importance of these capabilities, which was completed by 1446 mostly UK and Australian clients. The data have allowed us to develop a 'Client Hierarchy of Needs' which emphasises the fundamental importance of commitment to animal welfare and veterinary capabilities to the client experience. This study is part of the VetSet2Go project, a collaborative international project to define the capabilities most important for employability and success in the veterinary profession today.

Adaptive Comparative Judgment: A Tool to Support Students' Assessment Literacy.

Comparative judgment in assessment is a process whereby repeated comparison of two items (e.g., assessment answers) can allow an accurate ranking of all the submissions to be achieved. In adaptive comparative judgment (ACJ), technology is used to automate the process and present pairs of pieces of work over iterative cycles. An online ACJ system was used to present students with work prepared by a previous cohort at the same stage of their studies. Objective marks given to the work by experienced faculty were compared to the rankings given to the work by a cohort of veterinary students (n=154). Each student was required to review and judge 20 answers provided by the previous cohort to a free-text short answer question. The time that students spent on the judgment tasks was recorded, and students were asked to reflect on their experiences after engaging with the task. There was a strong positive correlation between student ranking and faculty marking. A weak positive correlation was found between the time students spent on the judgments and their performance on the part of their own examination that contained questions in the same format. Slightly less than half of the students agreed that the exercise was a good use of their time, but 78% agreed that they had learned from the process. Qualitative data highlighted different levels of benefit from the simplest aspect of learning more about the topic to an appreciation of the more generic lessons to be learned.

Development, Evaluation, and Evolution of a Peer Support Program in Veterinary Medical Education.

The majority of peer support programs in UK universities focus on academic support (e.g., through peer-assisted learning programs). Following student consultation, a pilot pastoral-based student peer support program was developed and implemented in a UK veterinary school. Thirty-one students were trained in the pilot year, and continued with the program to the end of the academic year (and beyond). The trainees were asked for feedback at the end of training and at the end of the year; the rest of the student body was surveyed as to their perception of the peer support program at the end of the year. Feedback from the training (N=19) was positive, with themes of enhanced self-development, improved communication skills, and bonding with other trainees. The wider student body responded (N=497) with concerns over confidentiality within a small community and distrust due to the competitive environment. Despite this, however, most students (74%) agreed that having peer support available created a supportive atmosphere, even if they did not personally plan on using the program. The paper concludes with a description of the changes being made to the program as a result of the evaluation.

Strain-dependent cellular immune responses in cattle following Escherichia coli O157:H7 colonization.

Enterohemorrhagic Escherichia coli (EHEC) O157:H7 causes hemorrhagic diarrhea and potentially fatal renal failure in humans. Ruminants are considered to be the primary reservoir for human infection. Vaccines that reduce shedding in cattle are only partially protective, and their underlying protective mechanisms are unknown. Studies investigating the response of cattle to colonization generally focus on humoral immunity, leaving the role of cellular immunity unclear. To inform future vaccine development, we studied the cellular immune responses of cattle during EHEC O157:H7 colonization. Calves were challenged either with a phage type 21/28 (PT21/28) strain possessing the Shiga toxin 2a (Stx2a) and Stx2c genes or with a PT32 strain possessing the Stx2c gene only. T-helper cell-associated transcripts at the terminal rectum were analyzed by reverse transcription-quantitative PCR (RT-qPCR). Induction of gamma interferon (IFN-γ) and T-bet was observed with peak expression of both genes at 7 days in PT32-challenged calves, while upregulation was delayed, peaking at 21 days, in PT21/28-challenged calves. Cells isolated from gastrointestinal lymph nodes demonstrated antigen-specific proliferation and IFN-γ release in response to type III secreted proteins (T3SPs); however, responsiveness was suppressed in cells isolated from PT32-challenged calves. Lymph node cells showed increased expression of the proliferation marker Ki67 in CD4(+) T cells from PT21/28-challenged calves, NK cells from PT32-challenged calves, and CD8(+) and γδ T cells from both PT21/28- and PT32-challenged calves following ex vivo restimulation with T3SPs. This study demonstrates that cattle mount cellular immune responses during colonization with EHEC O157:H7, the temporality of which is strain dependent, with further evidence of strain-specific immunomodulation.