What do primary care staff know and do about blood borne virus testing and care for migrant patients? A national survey.

BACKGROUND: UK migrants born in intermediate to high prevalence areas for blood borne viruses (BBV) including hepatitis B, hepatitis C and HIV are at increased risk of these infections. National guidance from Public Health England (PHE) and National Institute for Health and Care Excellence (NICE) recommends primary care test this population to increase diagnoses and treatment. We aimed to investigate primary care professionals' knowledge of entitlements, and perceptions of barriers, for migrants accessing healthcare, and their policies, and reported practices and influences on provision of BBV testing in migrants. METHODS: A pre-piloted questionnaire was distributed between October 2017 and January 2018 to primary care professionals attending the Royal College of General Practitioners and Best Practice in Primary Care conferences, via a link in PHE Vaccine Updates and through professional networks. Survey results were analysed to give descriptive statistics, and responses by respondent characteristics: profession, region, practice size, and frequency of seeing migrant patients. Responses were considered on a per question basis with response rates for each question presented with the results. RESULTS: Four hundred fourteen questionnaires were returned with responses varying by question, representing an estimated 5.7% of English GP practices overall. Only 14% of respondents' practices systematically identified migrant patients for testing. Universal opt-out testing was offered to newly registering migrant patients by 18% of respondents for hepatitis B, 17% for hepatitis C and 21% for HIV. Knowledge of healthcare entitlements varied; fewer clinical staff knew that general practice consultations were free to all migrants (76%) than for urgent care (88%). Performance payment structure (76%) had the greatest reported influence on testing, followed by PHE and Clinical Commissioning Group recommendations (73% each). Language and culture were perceived to be the biggest barriers to accessing care. CONCLUSIONS: BBV testing for migrant patients in primary care is usually ad hoc, which is likely to lead to testing opportunities being missed. Knowledge of migrants' entitlements to healthcare varies and could affect access to care. Interventions to improve professional awareness and identification of migrant patients requiring BBV testing are needed to reduce the undiagnosed and untreated burden of BBVs in this vulnerable population.

Should we video OSCEs for student appeals?

BACKGROUND: Those setting objective structured clinical exams (OSCEs) are likely to encounter candidates who dispute the examiners' scores and feedback. At our own institution, candidates have requested video recording to aid in later academic appeals. Before ceding to such requests, we wished to be certain that the marking of recorded OSCEs would give comparable results to live marking, and that technical challenges could be met within reasonable cost. METHODS: We adopted a mixed-methods approach to explore the use of video recording OSCEs. Following an initial literature review, we surveyed and interviewed the assessment leads of UK medical schools and postgraduate institutions setting high stakes OSCEs to explore their views and experience in using recordings as part of summative OSCE assessments. RESULTS: Results from our literature review reveal inconsistent findings about the comparability of marks awarded from video marking and those awarded by examiner in-station marking, with suggestions that video marking generates lower scores. The majority of UK medical education institutions were neither videoing OSCEs nor considering doing so. Many logistical and assessor-related drawbacks to video review were identified, with significant concerns raised about how such a process could be feasibly managed. DISCUSSION: Although the videoing of OSCEs may superficially appear an easy solution to provide defensibility of the process, the potential use is beset with challenge, going beyond purely logistical and technical difficulties. The use of videoing for the purpose of OSCE appeals is not currently supported by the literature, nor by the majority of UK undergraduate and postgraduate medical education institutions delivering high-stakes summative OSCEs.

Clinical Debrief: learning and well-being together.

BACKGROUND: Clinical environments can be so stressful to medical students as to be detrimental to their learning and well-being. Our intervention, Clinical Debrief, integrates learning through clinical experience with the development of positive coping strategies. Students shared cases and experiences during weekly small group classroom discussions, facilitated by general practitioners (from outside their current hospital placement), throughout two consecutive 12-week blocks of their first clinical year. Alongside enquiry-based and clinical reasoning learning, we gave students a safe space to reflect on their affect. Our aim was to critically examine students' views in Clinical Debrief. METHOD: Anonymised quantitative and qualitative evaluation data were collected over 3 years using online questionnaires on completion of each 12-week block. The data relating to psychological supervision were analysed independently and in parallel, using thematic analysis for qualitative data. We aim to help students develop positive coping mechanisms, promoting empathy,self-awarenessand wellbeing RESULTS: A total of 1857 evaluations were extracted (response rate 67%). The median (interquartile range) overall rating for Clinical Debrief sessions was 9 (8-10), where 10 indicates 'excellent' and 1 indicates 'significant improvement needed'. The rating for the supervisory aspects of the sessions and free-text comments were positive. Students appreciated safe environments, the session structure, facilitator role modelling, transitional support and processing of emotional experiences. DISCUSSION: Mandatory integrated longitudinal supervision, using trained clinician facilitators, was positively received by students in transition to clinical placements. Normalising the emotional impact of medical work destigmatises distress. Linking clinical reasoning with affective state awareness to contextualise case management, following Mezirow's transformative learning theory, brings added benefit to learning and well-being. Student demand for the expansion of Clinical Debrief is evidence of success.