Twelve tips for optimising learning for postgraduate doctors in the operating theatre.

Learning in the operating theatre forms a critical part of postgraduate medical education. Postgraduate doctors present a diverse cohort of learners with a wide range of learning needs that will vary by their level of experience and curriculum requirements. With evidence of both trainee dissatisfaction with the theatre learning experience and reduced time spent in the operating theatre, which has been exacerbated by the effects of the Covid-19 pandemic, it is vital that every visit to the operating theatre is used as a learning opportunity. We have devised 12 tips aimed at both learners and surgeons to optimise learning in the operating theatre, set out into four domains: educational context, preparation, learning in theatre, feedback and reflection. These tips have been created by a process of literature review and acknowledgment of established learning theory, with further discussion amongst surgical trainees, senior surgical faculty, surgical educators and medical education faculty.

Students' Experiences of Peer Observed Teaching: A Qualitative Interview Study.

PHENOMENON: Development of teaching skills is an important aspect of medical student training. One method of developing teaching skills is participation in peer teaching with observation and feedback from peers. This study aims to explore student teachers' experiences of peer observation of teaching and how they intend to utilize this feedback. APPROACH: We conducted individual semi-structured interviews with peer tutors who had experienced peer observation of their small group teaching and subsequent feedback. The interviews were conducted by a medical student peer not involved in the peer observation of teaching scheme. They were audio recorded and transcribed. The pseudonymised transcripts were coded independently by two researchers using thematic analysis. FINDINGS: Nine students participated in interviews lasting a mean of 42 minutes. We identified three main themes: motivations for observation, experiences of observation, and responses to feedback. Students were motivated to have their teaching observed by both intrinsic and extrinsic factors: to develop their skills and competence as a teacher, in recognition of the important role this plays in their career, to provide reassurance that they are providing good quality teaching, to ensure the content of their teaching is appropriate and accurate, and to provide evidence of engagement in, and development of, teaching. Students described feeling nervous before the observations and preparing more for their teaching than they might normally, however, during the observations they felt more comfortable which they attributed to the peer-peer relationship. Students described finding the narrative feedback more useful than the quantitative elements as it provided more detail as to how they might improve. Several students described how they have used the feedback they have received on their teaching to improve subsequent sessions. INSIGHTS: Peer observation of teaching is a useful and acceptable method of providing feedback on student teaching and recipients intend to use this feedback to improve their teaching.

'I'd have to fight for my life there': a multicentre qualitative interview study of how socioeconomic background influences medical school choice.

Students from lower socio-economic backgrounds who were educated in state funded schools are underrepresented in medicine in the UK. Widening access to medical students from these backgrounds has become a key political and research priority. It is known that medical schools vary in the number of applicants attracted and accepted from non-traditional backgrounds but the reasons for this are poorly understood. This study aims to explore what applicants value when choosing medical schools to apply to and how this relates to their socioeconomic background. We conducted a multicentre qualitative interview study, purposively sampling applicants and recent entrants based on socioeconomic background, stage of application and medical school of application. We recruited participants from eight UK medical schools. Participants attended semi-structured interviews. We performed a framework analysis, identifying codes inductively from the data. Sixty-six individuals participated: 35 applicants and 31 first year medical students. Seven main themes were identified; course style, proximity to home, prestige, medical school culture, geographical area, university resources, and fitting in. These were prioritised differently depending on participants' background. Participants from lower socioeconomic backgrounds described proximity to home as a higher priority. This was typically as they intended to be living at home for at least part of the course. Those from higher socioeconomic backgrounds were more concerned with the perceived prestige of medical schools. Since medicine is a highly selective course, only offered at a minority of UK higher education institutions, these differences in priorities may help explain observed differential patterns of medical school applications and success rates by applicant social background.

Institutional choice among medical applicants: a profile paper for The United Kingdom Medical Applicant Cohort Study (UKMACS) prospective longitudinal cohort study.

PURPOSE: To generate a large cohort of those in 2019 seriously considering applying to study Medicine, collecting data on a range of socioeconomic and other demographic factors that influence choice of medical schools and to link to other datasets to form a longitudinal study of progress through medical school and careers in medicine. DESIGN: Cross-sectional questionnaire studies, part of the longitudinal UK Medical Applicant Cohort Study (UKMACS). SETTING: UK medical school admissions in 2020. PARTICIPANTS: UK residents aged 16+ and seriously considering applying to study Medicine. The cohort was primarily drawn from those registering in 2019 for the U(K)CAT (University Clinical Aptitude Test (formerly the UK Clinical Aptitude Test)) with additional potential applicants responding to an open call. Participants consented to their data being linked within the UK Medical Education Database. FINDINGS TO DATE: UKMACS Wave 1 questionnaire respondents consisted of 6391 consenting respondents from across the UK. In 2019, 14 980 of the 17 470 UK-domiciled medicine applicants were first-time applicants. The questionnaires show that many of these applicants have a need for more help and guidance to make informed choices, with less advantaged groups reporting themselves as being at a disadvantage when applying due to limited understanding of information and limited access to guidance to enable informed and effective decision-making. FUTURE PLANS: To link the cohort with successive Universities and Colleges Admissions Service and other datasets to analyse outcomes of applications and establish national longitudinal evidence to understand how medical choices are made and how they impact on educational, career and workforce outcomes.

A method for the madness: An international survey of health professions education authors' journal choice.

INTRODUCTION: Scholarship is a key activity in health professions education (HPE). When disseminating scholarly work, how one selects the journal to which they submit is often argued to be a key determinant of subsequent success. To draw more evidence-based recommendations in this regard, we surveyed successful scholars working in HPE regarding their perspectives and experiences with journal selection. METHODS: We conducted an international survey of HPE scholars, investigating their decisions regarding journal choice. Corresponding authors were identified from a sample of 4000 papers published in 2019 and 2020. They were invited via email with up to four reminders. We describe their experience and use principle component and regression analyses to identify factors associated with successful acceptance. RESULTS: In total, 863 responses were received (24.7% response rate), 691 of which were included in our analyses. Two thirds of respondents had their manuscripts accepted at their first-choice journal with revisions required in 98% of cases. We identified six priority factors when choosing journals. In descending order of importance, they were: fit, impact, editorial reputation, speed of dissemination, breadth of dissemination, and guidance from others. Authors who prioritised fit higher and who selected a journal earlier were more likely to have their manuscripts accepted at their first-choice journal. DISCUSSION: Based on our results we make three recommendations for authors when writing manuscripts: do not be disheartened by a revise decision, consider journal choice early in the research process, and use the fit between your manuscript and the journal as the main factor driving journal choice.

Social media in undergraduate medical education: A systematic review.

INTRODUCTION: There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high-quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. METHODS: Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. RESULTS: 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self-reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. CONCLUSIONS: Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher-quality study is required to identify longer-term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms.

Levelling the playing field: students' motivations to contribute to an amnesty of assessment materials.

BACKGROUND: 'Exam recall' is a recognised phenomenon whereby students recall and record questions after leaving the examination hall. This poses two main problems. First, as these questions are only available to peers of the students who recall the questions, these individuals have an unfair advantage. Secondly, the distribution of these recalled questions poses a threat to the validity and defensibility of assessments. To address the first of these problems, we developed an amnesty enabling students to submit assessment material to an on-line site. This study sought to explore which factors influence students' contributions to an amnesty of assessment material. METHODS: We conducted a qualitative study using semi-structured focus groups. We used convenience sampling and recruited participants from all years of our undergraduate medical programme. The focus groups were facilitated by a medical student peer to reduce the power imbalance and encourage participants to discuss candidly. The focus groups were audio recorded and transcribed verbatim. Two researchers independently analysed all transcripts using thematic analysis and the research team met regularly to discuss emergent findings. Nvivo was used to assist with thematic analysis of the transcripts. RESULTS: Twenty-six individuals participated in six focus groups. Six themes were identified through the analysis, which were categorised into motivating factors and de-motivating factors. Motivating factors were a perception that this would overcome inequity, a fear of repercussions, and the perceived usefulness of resources. Factors that prevented students contributing were a culture of competition, a lack of incentives, and mistrust of the medical school. CONCLUSIONS: The establishment of an amnesty was acceptable to students and they were motivated to contribute materials. The competitive nature of medical careers and the stakes of summative assessments meant that students felt that some peers might still not contribute their materials. Students felt that the school were listening to their concerns and this led to a better dialogue between students and faculty.

Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63.

BACKGROUND: The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020. This rapid systematic review synthesised published reports of medical educational developments in response to the pandemic, considering descriptions of interventions, evaluation data and lessons learned. METHODS: The authors systematically searched four online databases and hand searched MedEdPublish up to 24 May 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias for included articles. Discrepancies were resolved by a third author. A descriptive synthesis and outcomes were reported. RESULTS: Forty-nine articles were included. The majority were from North America, Asia and Europe. Sixteen studies described Kirkpatrick's outcomes, with one study describing levels 1-3. A few papers were of exceptional quality, though the risk of bias framework generally revealed capricious reporting of underpinning theory, resources, setting, educational methods, and content. Key developments were pivoting educational delivery from classroom-based learning to virtual spaces, replacing clinical placement based learning with alternate approaches, and supporting direct patient contact with mitigated risk. Training for treating patients with COVID-19, service reconfiguration, assessment, well-being, faculty development, and admissions were all addressed, with the latter categories receiving the least attention. CONCLUSIONS: This review highlights several areas of educational response in the immediate aftermath of the COVID-19 pandemic and identifies a few articles of exceptional quality that can serve as models for future developments and educational reporting. There was often a lack of practical detail to support the educational community in enactment of novel interventions, as well as limited evaluation data. However, the range of options deployed offers much guidance for the medical education community moving forward and there was an indication that outcome data and greater detail will be reported in the future.

The epidemiology of teaching and training General Practices in England.

There is no national picture of teaching and training practices or the communities they serve. We aimed to describe the association between general practices' engagement with education and their characteristics, locality and patients' health-status and satisfaction. This data linkage study of all English practices calculated odds ratios for teaching and training status and practice, locality and patient variables. Teaching and training practices are larger than practices which do neither (mean list size (SD) 7074 (3736), 10112 (4934), and 5327 (3368) respectively, p < 0.001 and have fewer patients per GP (1932 (951), 1838 (544), and 2117 (1585) respectively, p < 0.001). Their localities have a higher proportion of White British residents (77.99% (24.17), 81.66% (20.81), 73.07% (26.91), p < 0.001). Practices with more GPs (OR 1.21 (95%CI 1.18-1.20)), fewer male GPs (0.45 (0.36-0.55)) and a higher proportion of White British people in their locality (1.30 (1.06-1.60)) were more likely to teach. Practices in rural areas (1.68 (1.43-1.98)), with more GPs (1.22 (1.27-1.39)), more full time equivalent GPs (2.68 (1.64-4.40)), fewer male GPs (0.17 (0.13-0.22)) and a higher proportion of White British people in their locality (1.34 (1.02-1.75)) were more likely to train. Teaching and training practices had higher patient satisfaction (0.293 (0.190, 0.397) and (0.563 (0.442, 0.685)) respectively and quality and outcomes framework scores (0.507 (0.211, 0.804)) and (0.996 (0.650, 1.342)) respectively than those which did not. Educationally engaged practices are unrepresentative in serving less ethnically diverse and (for training practices) less urban environments. Investment is needed to increase the proportion of educational practices in diverse urban localities.

WATCH Scrubs: a video observational study of workplace-based learning at Sacred Heart Hospital.

CONTEXT: Workplace-based learning remains the cornerstone of clinical training. Teaching in the clinical environment promotes active engagement as trainees are required to combine their competencies (e.g. skills in history taking, examination and clinical reasoning) to determine an appropriate course of action. High-quality clinical teaching supports and scaffolds trainees' learning in clinical workplaces. OBJECTIVES: This study aimed to explore the quality of clinical teaching at a large teaching hospital. METHODS: A retrospective video observational study of 9 years of workplace-based learning at Sacred Heart Hospital, a large private teaching hospital, was conducted. Each academic year was observed by one researcher. Clinical teaching encounters were identified and analysed using the Warwick Assessment insTrument for Clinical teacHing (WATCH). Descriptive observation notes were recorded and analysed thematically. RESULTS: A total of 131 teaching encounters provided by 12 tutors were identified. The 15-item instrument demonstrated a Cronbach's alpha of 0.89. The hidden curriculum, role modelling and reflection played prominent roles in trainees' personal and professional development. CONCLUSIONS: Trainees' learning in clinical workplaces extends beyond the formal teaching they receive to include the development of professional behaviours through role modelling and reflection on clinical encounters.

Evidence regarding the utility of multiple mini-interview (MMI) for selection to undergraduate health programs: A BEME systematic review: BEME Guide No. 37.

BACKGROUND: In the 11 years since its development at McMaster University Medical School, the multiple mini-interview (MMI) has become a popular selection tool. We aimed to systematically explore, analyze and synthesize the evidence regarding MMIs for selection to undergraduate health programs. METHODS: The review protocol was peer-reviewed and prospectively registered with the Best Evidence Medical Education (BEME) collaboration. Thirteen databases were searched through 34 terms and their Boolean combinations. Seven key journals were hand-searched since 2004. The reference sections of all included studies were screened. Studies meeting the inclusion criteria were coded independently by two reviewers using a modified BEME coding sheet. Extracted data were synthesized through narrative synthesis. RESULTS: A total of 4338 citations were identified and screened, resulting in 41 papers that met inclusion criteria. Thirty-two studies report data for selection to medicine, six for dentistry, three for veterinary medicine, one for pharmacy, one for nursing, one for rehabilitation, and one for health science. Five studies investigated selection to more than one profession. MMIs used for selection to undergraduate health programs appear to have reasonable feasibility, acceptability, validity, and reliability. Reliability is optimized by including 7-12 stations, each with one examiner. The evidence is stronger for face validity, with more research needed to explore content validity and predictive validity. In published studies, MMIs do not appear biased against applicants on the basis of age, gender, or socio-economic status. However, applicants of certain ethnic and social backgrounds did less well in a very small number of published studies. Performance on MMIs does not correlate strongly with other measures of noncognitive attributes, such as personality inventories and measures of emotional intelligence. DISCUSSION: MMI does not automatically mean a more reliable selection process but it can do, if carefully designed. Effective MMIs require careful identification of the noncognitive attributes sought by the program and institution. Attention needs to be given to the number of stations, the blueprint and examiner training. CONCLUSION: More work is required on MMIs as they may disadvantage groups of certain ethnic or social backgrounds. There is a compelling argument for multi-institutional studies to investigate areas such as the relationship of MMI content to curriculum domains, graduate outcomes, and social missions; relationships of applicants' performance on different MMIs; bias in selecting applicants of minority groups; and the long-term outcomes appropriate for studies of predictive validity.

How does peer teaching compare to faculty teaching? A systematic review and meta-analysis (.).

PURPOSE: In undergraduate medical education, peer-teaching has become an established and common method to enhance student learning. Evidence suggests that peer-teaching provides learning benefits for both learners and tutors. We aimed to describe the outcomes for medical students taught by peers through systematic review and meta-analysis of existing literature. METHODS: Seven databases were searched through 21 terms and their Boolean combinations. Studies reporting knowledge or skills outcomes of students taught by peers compared to those taught by faculty or qualified clinicians were included. Extracted data on students' knowledge and skills outcomes were synthesised through a random effects model meta-analysis. RESULTS: The search yielded 2292 studies. Five hundred and fifty-three duplicates and 1611 irrelevant articles were removed during title-screening. The abstracts of 128 papers were screened against the inclusion and exclusion criteria. Ten studies have been included in the review. Meta-analyses showed no significant difference in peer-teaching compared to faculty teaching for knowledge or skills outcomes, standardised mean differences were 0.07 (95% CI: -0.07, 0.21) and 0.11 (95% CI: -0.07, 1.29), respectively. CONCLUSION: Students taught by peers do not have significantly different outcomes to those taught by faculty. As the process of teaching helps to develop both tutor knowledge and teaching skills, peer-teaching should be supported.

Developing students' teaching through peer observation and feedback.

With the increasing popularity and scale of peer teaching, it is imperative to develop methods that ensure the quality of teaching provided by undergraduate students. We used an established faculty development and quality assurance process in a novel context: peer observation of teaching for undergraduate peer tutors. We have developed a form to record observations and aid the facilitation of feedback. In addition, experienced peer tutors have been trained to observe peer-taught sessions and provide tutors with verbal and written feedback. We have found peer observation of teaching to be a feasible and acceptable process for improving quality of teaching provided by undergraduate medical students. However, feedback regarding the quality of peer observer's feedback may help to develop students' abilities further.