Dundee's Longitudinal Integrated Clerkship: drivers, implementation and early evaluation.

Dundee University School of Medicine established a pilot for a 40 week long comprehensive Longitudinal Integrated Clerkship (LIC) in 2016. Ten places for year 4 students are available which are shared between two regions of Scotland which are largely rural areas by UK definitions. This paper describes the drivers for the pilot, its implementation and early evaluation. For the evaluation, data were collected using focus groups and semi-structured interviews from the first cohort of seven students, four health service employed staff (two with leadership roles and two with regional student facing roles), 21 General Practitioner tutors, and from reflective audio-diaries kept by all students. Analysis was thematic, the themes being identified from the data. Summative assessment data were collated. Students reported positive learning experiences though access to secondary care learning linked to their patients was sometimes problematic. GP tutors were positive and enthusiastic about the programme and could see the potential benefits on recruitment to GP careers. Pre-existing workload pressures were a challenge. Summative assessment results were encouraging. The Dundee LIC is successful in delivering Dundee's year 4 curriculum. Ongoing development has been focused on improving awareness of the programme in secondary care services.

Foundation doctors and dyslexia: a qualitative study of their experiences and coping strategies.

BACKGROUND: Dyslexia is the most common form of specific learning difficulty affecting approximately 6% of the general UK population and believed to affect approximately 2% of UK medical students. The impact of dyslexia on early practice has not been studied. OBJECTIVES: To develop an understanding of the challenges faced by doctors with dyslexia in the first year of practice and their support requirements. METHODS: Semistructured telephone interviews were conducted with seven foundation year 1 doctors with dyslexia from Scottish hospitals between March 2013 and August 2013. RESULTS: Foundation doctors indicated that due to their dyslexia, they experience difficulty with all forms of communication, time management and anxiety. There were concerns about disclosure of their dyslexia to colleagues and supervisors. Coping strategies used frequently were safety-netting and planning; technology solutions did offer some assistance. CONCLUSIONS: Although technological interventions have the potential to offer benefits to foundation doctors with dyslexia, increased openness about a diagnosis of dyslexia with discussion between doctor and supervisors about the challenges and anxieties is likely to provide the most benefit.

Communication training for international graduates.

INTRODUCTION: International Medical Graduates (IMGs) are more likely to be involved in complaints and have lower pass rates for professional examinations. Language barriers and differences in culture and consulting style are suggested to be the cause. A programme was developed in Dumfries and Galloway to address these issues, aiming to provide language and consultation skills training, and create a culture where these issues could be discussed openly. METHODS: There was voluntary recruitment of participants to a programme of consultation and language skills delivered by experienced general practitioner (GP) trainers and an experienced language tutor. The course was assessed using objective measurement of language and consultation skills and feedback from participants, tutors and educational supervisors. RESULTS: The programme was fully subscribed with a wide range of experience amongst participants, although the absolute numbers were small. Objective improvement was seen in all areas of language assessed, with improvements also seen in consultation skills. The programme was popular with educational supervisors and with participants, who would all like to see it continue. The tutors noted that participants became increasingly reflective, and also believe that the course should continue. CONCLUSIONS: The programme was valued by all those involved, and showed that short-term interventions can improve language and consultation skills, potentially helping to address the challenges faced by this particular group of doctors.

Do we know what foundation year doctors think about patient safety incident reporting? Development of a Web based tool to assess attitude and knowledge.

BACKGROUND: Making healthcare safer is an international priority. Patient safety modules are now taught in medical schools, and methods to assess related student knowledge and attitudes have been developed. However, little is known about the attitudes and knowledge which foundation doctors are developing to patient safety and incident reporting in the healthcare workplace, since a specific assessment tool appears to be lacking. AIMS: To develop, content validate and pilot test an online questionnaire survey to elicit foundation doctors' knowledge and experience of patient safety and incident reporting, and assess related attitudes and behaviours. METHODS: Questionnaire content validity was facilitated through: a steering group; literature review; feedback from foundation year doctors and consultant staff; a modified Delphi group; and completion of a content validity index by experts. In 2010 a cross-sectional online survey of 110 foundation year 1 and 2 doctors was then undertaken in three Scottish NHS board areas, utilising the developed 25 item questionnaire. RESULTS: The questionnaire was validated, and piloted among 69 foundation year doctors who responded to the questionnaire. The pilot has provided valuable insights into trainee attitudes and experience. For example, 32 (48%) believed that most safety incidents were due to things that they could not do anything about; and 31 (43%) admitted to being involved in medication errors which were not formally reported. CONCLUSIONS: The pilot study was successful in taking the first steps to developing a validated survey questionnaire for a key staff group, foundation year doctors, in a priority area. However, the findings raise concerns about trainee experience of and attitudes to reporting, and the frequency with which incidents go unreported.

Web-based learning strategies in combination with published guidelines to change practice of primary care professionals.

BACKGROUND: Published clinical guidelines need to be combined with effective educational interventions to produce change in practice. Problem-based learning (PBL) groups are effective; however, research studies have not looked at change in practice following PBL that is independent of group interaction. AIM: To determine whether clinical guidelines combined with modified PBL e-learning modules, in which dialogue between learners is replaced by interaction with a computer, could increase knowledge, result in changes in practice, and be acceptable to participants as a mode of modifying practice. DESIGN OF STUDY: Quantitative and qualitative methods. SETTING: Web-based application. RESULTS: Online PBL modules were studied by 45 primary care clinicians. Replacement of group functions by interaction with the computer was found to be an acceptable form of learning, and resulted in reported changes in practice among GPs choosing this method of study. This study shows that changes were independent of demonstrable knowledge gains. CONCLUSION: Online PBL modules could complement other arms of guideline-implementation strategies. More work is needed to determine which groups would benefit most.

Reflective testing: what do patients think?

INTRODUCTION: Reflective testing refers to the practice of adding on tests by laboratory staff. Little is known about what patients think of this practice. METHODS: We surveyed patients attending a general practice surgery and patients attending hospital outpatient clinics. We sought their views about the practice of adding on tests and about the information they received from requesting clinicians about their investigations. RESULTS: In both groups of patients, large majorities favoured an approach in which relevant additional tests are performed without consulting the requesting clinician or patient first. Most patients also felt that the requesting clinicians had provided a satisfactory explanation about what tests were to be performed and why. CONCLUSION: Most patients are content to let NHS professionals add on relevant tests if this is felt to be in their interest.