How to discuss transferability of qualitative research in health professions education.

Transferability is commonly identified as a quality criterion for qualitative research. This criterion was introduced by Lincoln and Guba to describe the degree to which a study's findings can be transferred to other contexts, settings or respondents. In this How To paper, we present a more nuanced, multidimensional view of transferability and explain relevant concepts, reflexive approaches and specific techniques to guide researchers in discussing transferability. We identify three dimensions of transferability for use in many approaches to qualitative research: applicability, resonance and theoretical engagement. Transferability as applicability relates to providing sufficient information for readers to evaluate the relevance of findings to other contexts. Transferability as resonance requires the researcher to present the research in a way that evokes a sense of familiarity or shared experience. Transferability as theoretical engagement refers to ways the researcher uses theory to frame a problem, connects findings to existing constructs and/or proposes a model or theory that could explain a process or phenomenon. We encourage researchers to consider all three dimensions of transferability when developing and presenting their work, keeping in mind that some dimensions may be more relevant than others based on study methodology and project goals.

How to support others in developing a career in clinical education research.

The Incubator for Clinical Education Research (ClinEdR) is a UK-wide network, established with support from the National Institute for Health Research, to lead initiatives to build capacity in the field. A key barrier identified by this group is that many experienced educators, clinicians, and researchers, who may be committed to supporting others, have little guidance on how best to do this. In this "How to …" paper, we draw on relevant literature and our individual and collective experiences as members of the National Institute for Health Research ClinEdR incubator to offer suggestions on how educators can support others to develop successful careers involving ClinEdR. This article offers guidance and inspiration for all professionals whose role involves research and scholarship and who encounter aspiring or developing clinical education researchers in the course of their work. It will also be of interest to researchers who are starting out and progressing in the field.

The interprofessional education of medical students and physician associate students during the COVID-19 pandemic.

Background: Due to the potential for improved team working and patient care, interprofessional education (IPE) is increasingly recognized as a core competency within the education of health-care professionals. Methods: In response to cancellation of the physician associate (PA) acute medicine clinical placement at our institution following COVID-19, a technology-focused, case-based IPE course between medical and PA students was implemented. The course consisted of 6 weekly seminars involving an average of 16 PA students, two medical students, and two supervising general practitioners. Course evaluation was mixed methods, comprising pre/postcourse questionnaires, weekly feedback forms, and postcourse e-mail interviews. Results: The course improved the confidence and perceived knowledge base of all participating students across every clinical topic covered, while promoting interprofessional collaboration and understanding. Discussion: To our knowledge, this represents one of the first IPE courses implemented between medical and PA students alone and has highlighted the need for further IPE courses between both professions. We show that successful IPE is feasible during a global pandemic, and that initiatives relying on technology alone are successful. Weekly written feedback was overwhelmingly positive, and based on the success of this course, faculty have planned further IPE opportunities between both professions.

Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the UK.

OBJECTIVE: To better understand the broader experience of medical students impacted by discrimination and the support systems they engage with. DESIGN: Qualitative study using semi-structured interviews. SETTING: Four medical schools based in the UK. PARTICIPANTS: 17 medical students were recruited using volunteer and snowball sampling: all students self-identified as being impacted by discrimination. RESULTS: 5 themes were identified: feelings of isolation, imposter syndrome and exclusion; a lack of representation and positive role modelling; the importance of peer support; issues relating to the accessibility of support; building support networks through shared experiences and attempts to foster a sense of inclusion through peer and institutionally led initiatives. CONCLUSIONS: The findings of this study suggest medical schools could do more to recognise the importance of acknowledging the multiple identities at risk of discrimination held by students, perpetuating feelings of isolation and exclusion. Our research highlights the need for practical systemic initiatives to improve the sense of belonging of medical students who are impacted by discrimination. Medical educators and institutions should consider formal and informal provisions, such as creating time and space for students to meet and share experiences, access support and reporting networks, to foster a greater sense of belonging.

Beyond the bedside: protocol for a scoping review exploring the experiences of non-practicing healthcare professionals within health professions education.

BACKGROUND: The number of healthcare professionals leaving clinical practice and transitioning to alternative careers in health professions education is increasing. Among these non-practicing healthcare professionals, concerns have been reported regarding tensions in relation to identity, role, and credibility in their new field. There are suggestions that this is a particularly pressing issue for minoritised professionals who make this transition. Support is critical to attract and retain diverse talent within health professions education teaching and research. The purpose of this scoping review is to explore the career experiences of non-practicing healthcare professionals who work in health professions education internationally. METHODS: Arksey and O'Malley's framework has been utilised to guide the design of this scoping review process and will be used throughout the course of the review. A comprehensive search of seven electronic databases and limited search of Google Scholar will be conducted, as well as a hand search of eligible article reference lists. Two reviewers will independently screen all articles based on inclusion criteria, with conflicts resolved by a third reviewer. Data from included articles will be charted, collated, and analysed thematically. Meta-data will be summarised quantitatively. DISCUSSION: This scoping review aims to explore the role and experiences of non-practicing healthcare professionals working within health professions education. The review will follow established scoping review guidelines and will include studies from various regions and languages, provided an English translation is available. The study remit will be broad, including both quantitative and qualitative studies, as well as reviews and opinion papers. Limitations may include the exclusion of non-English articles and potential difficulty of identifying papers which discuss the experiences of non-practicing clinicians. However, the review will provide insight into the current knowledge on what it is like to be a non-practicing clinician working within health professions education and identify gaps for both future research, and future support for those making this career transition. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework Registration  https://doi.org/10.17605/OSF.IO/485Z3.

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.

How to define clinical education research terminology: A glossary.

Clinical education research (ClinEdR) utilises diverse terminology, which can lead to confusion. A common language is essential for enhancing impact. An expert panel drawn from various workstreams within the National Institute for Health and Care Research (NIHR) Incubator for Clinical Education Research was tasked with reviewing an initial list of terms for the development of a glossary of terms in the field of ClinEdR. The glossary was populated with terms, definitions and foundational papers by the authors and peer-reviewed for accuracy. The glossary of terms developed for ClinEdR should enable researchers to use a common language, promoting consistency and improving communication. We anticipate this will be useful for ClinEdR students and early career researchers. The glossary could be integrated into educational research methods courses in ClinEdR, and through critical and reflective use, enhance the quality and subsequent impact of ClinEdR.

On acknowledging silence within medical education.

INTRODUCTION: Silence is a part of all interactions, yet its potential significance within medical education remains underexplored. Existing literature primarily focuses on its use as a skill, leaving a gap in understanding its broader implications. Emerging evidence from higher education suggests that conceptualising silence as a way of being and becoming could enrich personal and professional growth. Unfolding dialogue on equality, diversity and inclusion suggests that silence on inequity can be oppressive. However, medical education has yet to consider the possible implications of conceptualising silence in this way. METHODS: We explore silence through the philosophical lens of acknowledgement. Acknowledgement-communicative behaviour that grants attention to others-is a philosophy with roots in phenomenology. It is concerned with being and becoming, and silence can be part of the communicative behaviour that constitutes acknowledgement. Our aim in exploring the ontological nature of silence (silence associated with being) using acknowledgement is to offer a springboard for practitioners, educators, and researchers to consider how silence is connected with our existence as people. RESULTS: Positive acknowledgement involves a commitment to turning towards the other and valuing this connection. Silence can be a way of demonstrating this-for example, giving patients the space they need to express their thoughts and emotions. Negative acknowledgement is the opposite and involves dismissing, ignoring or invalidating another's experiences. In the context of silence, negative acknowledgement may involve ignoring a person or group's ideas, or bystander silence when witness to discrimination. CONCLUSIONS: Within this work, we consider the ramifications of conceptualising silence as ontological, rather than purely a skill to be taught. This is a novel way of conceptualising silence, and there is a pressing need to explore this further to expand our understanding of the impact of silence for diverse groups of learners, educators, practitioners and patients.

Low estradiol production of non-laying whooping cranes (Grus americana) is associated with the failure of small follicles to enter follicular hierarchy.

For endangered species managed ex situ, production of offspring is a key factor to ensure healthy and self-sustaining populations. However, current breeding goals for the whooping crane (Grus americana) are impeded by poor reproduction. Our study sought to better understand mechanisms regulating ovarian function in ex situ managed whooping cranes and the regulatory function of the hypothalamic-pituitary-gonadal (HPG) axis in relation to follicle formation and egg laying. To characterize hormonal regulation of follicular development and ovulation, we collected weekly blood samples from six female whooping cranes during two breeding seasons, for a total of 11 reproductive cycles. The plasma samples were assessed for follicle stimulating hormone, luteinizing hormone, estradiol, and progesterone and the yolk precursors vitellogenin and very low-density lipoprotein. Ultrasonographic examination of the ovary was conducted at the time of blood collection. Preovulatory follicles (>12 mm) were present in laying cycles (n = 6) but absent in non-laying cycles (n = 5). The patterns of plasma hormone and yolk precursor concentrations corresponded to the stage of follicle development. Specifically, gonadotropin and yolk precursor concentrations increased as follicles transitioned from the non-yolky to yolky stage but did not increase further as the follicle advanced to preovulatory and ovulatory stages. Estrogen and progesterone concentrations increased as follicle size increased and reached peak concentrations (P < 0.05) when follicles developed to ovulatory and preovulatory stages, respectively. While overall mean circulating gonadotropin, progesterone, and yolk precursor concentrations did not differ for laying versus non-laying cycles, mean plasma estradiol in laying cycles was significantly higher than that in non-laying cycles. In summary, the findings suggested that disruption of mechanisms regulating follicle recruitment is likely responsible for the oviposition failure of the captive female whooping crane.

Examining medical student volunteering during the COVID-19 pandemic as a prosocial behaviour during an emergency.

PURPOSE: Understanding the factors that influence prosocial behaviour during the COVID-19 pandemic is essential due to the disruption to healthcare provision. METHODS: We conducted an in-depth, mixed-methods cross-sectional survey, from 2 May 2020 to 15 June 2020, of medical students at medical schools in the United Kingdom. Data analysis was informed by Latané and Darley's theory of prosocial behaviour during an emergency. RESULTS: A total of 1145 medical students from 36 medical schools responded. Although 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. Of the students, 92.7% understood they may be asked to volunteer; however, we found deciding one's responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students' decisions over whether they had the required skills and knowledge. CONCLUSION: We propose two additional domains to Latané and Darley's theory that medical students consider before making their final decision to volunteer: 'logistics' and 'safety'. We highlight modifiable barriers to prosocial behaviour and provide suggestions regarding how the conceptual framework can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process. Key messages  What is already known on this topic: There is a discrepancy between the number of students willing to volunteer during pandemics and disasters, and those who actually volunteer. Understanding the factors that influence prosocial behaviour during the current COVID-19 pandemic and future pandemics and disasters is essential. What this study adds: We expanded on Latané and Darley's theory of prosocial behaviour in an emergency and used this to conceptualize students' motivations to volunteer, highlighting a number of modifiable barriers to prosocial behaviour during the COVID-19 pandemic. How this study might affect research, practice, or policy: We provide suggestions regarding how the conceptual framework can be operationalized to support prosocial behaviours during emergencies for the ongoing COVID-19 pandemic and future crises.

Clinical support during COVID-19: An opportunity for service and learning? A cross-sectional survey of UK medical students.

PURPOSE: Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. METHODS: We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March-July 2020). Analysis was informed by the conceptual framework of service and learning. RESULTS: 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. CONCLUSION: The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.[Box: see text].

All medical degrees are equal, but some are more equal than others: An analysis of medical degree classifications.

BACKGROUND: Inequity in assessment can lead to differential attainment. Degree classifications, such as 'Honours', are an assessment outcome used to differentiate students after graduation. However, there are no standardised criteria used to determine what constitutes these awards. METHODS: We contacted all medical schools in the UK and collected data relating to classifications awarded, criteria used and percentage of students receiving classifications across the 5-year period prior to the 2019/2020 academic year. RESULTS: All 42 UK medical schools responded, and 36 universities provided usable data. Of these 36 universities, 30 (83%) awarded classifications above a 'Pass'. We identified four classifications above a 'Pass', and these were 'Commendation', 'Merit', 'Distinction' and 'Honours'. Sixteen (44%) universities awarded a single additional classification, and 14 (39%) universities awarded two or more. There was considerable variation in the criteria used by each university to award classifications. For example, 30 (67%) out of 45 classifications were dependent on all examined years, 9 (20%) for a combination of years and 6 (13%) for final year alone. Twenty-five of 30 universities that awarded classifications provided data on the percentage of students awarded a classification, and a median of 15% of students received any type of classification from their university (range 5.3% to 38%). There was a wide range in the percentage of students awarded each classification type across the universities (e.g. Honours, range = 3.1%-24%). CONCLUSIONS: We demonstrate considerable variation in the way UK medical degree classifications are awarded-regarding terminology, criteria and percentage of students awarded classifications. We highlight that classifications are another form of inequity in medical education. There is a need to fully evaluate the value of hierarchical degree awards internationally as the consequential validity of these awards is understudied.

Identity Development in Disorientating Times: the Experiences of Medical Students During COVID-19.

Introduction: Professional identity development is a central aim of medical education, which has been disrupted during COVID-19. Yet, no research has qualitatively explored COVID-19's impact across institutions or countries on medical students' identities. Kegan proposes a cognitive model of identity development, where 'disorientating dilemmas' prompt student development. Given the potential of COVID-related disruption to generate disorientating dilemmas, the authors investigated the ways in which COVID-19 influenced students' identity development. Methods: The authors conducted an international qualitative study with second year medical students from Imperial College London, and third year students from Melbourne Medical School. Six focus groups occurred 2020-2021, with three to six students per group. Authors analysed data using reflexive thematic analysis, applying Kegan's model as a sensitising theoretical lens. Results: COVID-19 has resulted in a loss of clinical exposure, loss of professional relationships, and a shift in public perception of physicians. Loss of exposure to clinical practice removed the external validation from patients and seniors many students depended on for identity development. Students' experiences encouraged them to assume the responsibilities of the profession and the communities they served, in the face of conflicting demands and risk. Acknowledging and actioning this responsibility facilitated identity development as a socially responsible advocate. Conclusions: Educators should consider adapting medical education to support students through Kegan's stages of development. Measures to foster relationships between students, patients, and staff are likely necessary. Formal curricula provisions, such as spaces for reflection and opportunities for social responsibility, may aid students in resolving the conflict many have recently experienced. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01592-z.

A novice's guide to qualitative health professions education research.

Qualitative research has long been considered the poor cousin to quantitative research. However, recently it has gained more prominence and respect, particularly within health professions education. This article aims to introduce the novice researcher to the fundamental principles of qualitative research. The objectives were (i) to understand the features of, and rationale for conducting, qualitative research, and (ii) to differentiate between the most common forms of qualitative research. In this review, we introduce the basic features of qualitative research, and describe the rationale for conducting such research. We guide researchers on how to differentiate between the most common forms of qualitative research and to take the time to acquaint themselves with research paradigms, the philosophical positions that guide how research is conducted and interpreted, before selecting the best methodology and methods. Qualitative research is rigorous, and offers deeper understanding of human experiences, context and social phenomena. We demonstrate the key considerations when selecting an appropriate methodology, ensuring that the research aim aligns with the purpose of any given methodology. The power of qualitative research should not be underestimated, but power only comes from well conducted, rigorous research. Qualitative research is not quick or easy but it has much to offer.