Peer assessment of professionalism attributes.

BACKGROUND: Peer assessment can support the development of professionalism by providing feedback that enables learners to reflect on their professional behavioural attributes. APPROACH: We developed and implemented an innovative online peer assessment and feedback tool. Students were encouraged to nominate 12 peer assessors to anonymously conduct their assessment. Assessors were presented with a list of 32 adjectives that described professional behavioural attributes within four domains (integrity, conscientiousness, agreeableness and resilience) and asked to rate the student by selecting a minimum of two adjectives in each domain and to provide free-text comments. The feedback was presented as a collated word cloud and free-text comments. All students had the opportunity to discuss their profiles with a staff member. EVALUATION: Our mixed-methods evaluation found that all students participated, and they valued the peer assessment and feedback process. Although the assessment was formative and confidential, students were reluctant to provide negative comments about their peers. 'Disengaged', 'aloof' and 'argumentative' were the most likely negative adjectives that indicated students with low-level professionalism concerns. IMPLICATIONS: Future development will focus on introducing students who can act as peer champions for the process and repeating the peer assessment over time to identify the change in professionalism development.

Curricular changes and interim posts during Covid-19: graduates' perspectives.

BACKGROUND: During the COVID-19 pandemic UK medical schools facilitated the early graduation of their final-year medical students to 'Foundation interim Year 1 (FiY1) doctors' through amendments made to curricula and final assessment. Such changes gave opportunity for evaluation. This study therefore aimed to explore 1) graduate perspective on the implementation of FiY1 and 2) how changes to course structures have affected self-reported preparedness for work. METHODS: Questionnaire surveys using Likert scale and free-text responses (n = 45), and semi-structured interviews (n = 7) were conducted with FiY1s from two UK medical schools contrasting in the amendments made to course structures. Data were analysed using quantitative methods and thematic analysis; 44% (n = 20) of respondents believed that governing health bodies had not communicated sufficiently prior to starting work. RESULTS: Graduates who had sat modified practical and written examinations reported 'legitimacy' and feeling more prepared compared to having not sat examinations (practical 100%, n = 17; written 88.3%, n = 15). Graduates from both schools agreed that carrying out assistantships as originally scheduled would have made them feel more prepared (91.1%, n = 41). CONCLUSIONS: The implementation of FiY1 was largely well received by graduates yet assistantship programmes may fulfil a similar role in normal times. Medical schools and governing bodies must ensure effective communication channels exist with students in order to better prepare them for their first posts, especially in times of crisis. Additionally, final examinations contribute to feelings of preparedness for work and instil a sense of legitimacy, a finding which is relevant to working within the current programmatic assessment structure.

Developing good practice by understanding how UK medical schools address low level concerns: a survey study.

In the literature, a distinction is made between low-level concerns and what is regarded as fitness to practise concerns. The General Medical Council expects all UK medical schools to have a transparent process in place about how concerns about its medical students are identified monitored and responded to. However, internationally, there is currently no well-established consensus on what is good practice in managing low-level concerns. Furthermore, currently, there is little information on how the UK medical schools vary in the processes they implement to monitor and respond to low-level concerns of their students. An online survey was developed and informed by the literature and sent to all UK medical schools to better understand their low-level concerns process. Of 39 medical schools invited, 25 participated. The data indicate variations between medical schools in the processes implemented. These variations can potentially influence the quality of the data; for example, whether there is a named person co-ordinating concerns between medical schools and placement providers. Furthermore, the data identify primary-care-based learning as offering missed opportunities where low-level concerns could be picked up. Key areas identified within the data for further work include how to quality assure that processes are equitable and how to bring more consistency to what sanctions are common and how these are decided up on.

Belongingness and its implications for undergraduate health professions education: a scoping review.

Belongingness is well recognised within higher education to have an important influence on the performance and well-being of learners. There appears to be little awareness of its importance in undergraduate health professions education. To identify how belongingness has been defined and measured, its impact on the performance and well-being of learners, and how it can be fostered in educational settings. A scoping review to map the published research in the wider higher education literature (including undergraduate health professions education). PubMed and ERIC were used. Only peer-reviewed articles in the English Language between 1996 and 2016 were included. Fifty-one relevant articles were identified with 16 related to nurse clinical education. No studies were found in undergraduate medical education or in primary care educational settings. Common features were identified within the several definitions of belongingness. A thematic analysis of articles revealed that belongingness has an important role in student motivation and learning identity formation and in facilitating positive mental health. The scoping review highlighted the importance of belongingness in higher and undergraduate health professions education, with implications for future practice and policy. Further research is recommended. There are important implications for curriculum development and delivery, including clinical placements; within secondary and primary care health professional education.

Introducing quality improvement teaching into general practice undergraduate placements.

Quality Improvement skills are deemed essential for future clinical practice of doctors by professional regulatory bodies. This paper presents the challenges of a curriculum development initiative to ensure that all medical students have involvement with a quality improvement project during a general practice placement in their fourth year. The curriculum development is described within a 'Plan-Do-Study-Act' framework. The learning is presented as a reflective discussion with conclusions and recommendations on how potential current barriers to implementing authentic participation in quality improvement projects for undergraduate medical students might be met. The key barriers include lack of opportunities within the curriculum structure to allow sufficient time for authentic quality improvement projects and a lack of confidence amongst placement tutors to support medical students with quality improvement projects.

Nursing students' perceptions of a video-based serious game's educational value: A pilot study.

BACKGROUND: Despite an increasing number of serious games (SGs) in nursing education, few evaluation studies specifically address their educational value in terms of face, content, and construct validity. OBJECTIVES: To assess nursing students' perceptions of a video-based SG in terms of face, content, and construct validity. In addition, the study assessed perceptions of usability, individual factors, and preferences regarding future use. DESIGN: A pilot study was conducted. SETTING AND PARTICIPANTS: An SG prototype was implemented as part of two simulation courses in nursing education: one for home health care and one for hospital medical-surgical wards. The SG aimed to teach clinical reasoning and decision-making skills to nursing students caring for patients with chronic obstructive pulmonary disease. A total of 249second-year nursing students participated in pilot testing of the SG. METHOD: A paper-based survey was used to assess students' perceptions of the SG's educational value. RESULTS: Overall, students from both simulation courses perceived the SG as educationally valuable and easy to use. No significant differences were found in perceptions of educational value between nursing students with previous healthcare experience versus those with none. However, significantly more students in the home healthcare simulation course indicated that the SG tested their clinical reasoning and decision-making skills. Students from both the medical-surgical and home healthcare simulation courses suggested that more video-based SGs should be developed and used in nursing education. CONCLUSIONS: Overall, the survey results indicate that the participants perceived the SG as educationally valuable, and that the SG has potential as an educational tool in nursing education, especially in caring for patients with chronic diseases and in home healthcare simulation. Showing a SG's educational value and user acceptance among nursing students may justify the development and application of more SGs in nursing education.

Developing a Serious Game for Nurse Education.

Future nursing education is challenged to develop innovative and effective programs that align with current changes in health care and to educate nurses with a high level of clinical reasoning skills, evidence-based knowledge, and professional autonomy. Serious games (SGs) are computer-based simulations that combine knowledge and skills development with video game-playing aspects to enable active, experiential, situated, and problem-based learning. In a PhD project, a video-based SG was developed to teach nursing students nursing care for patients with chronic obstructive pulmonary disease in home health care and hospital settings. The current article summarizes the process of the SG development and evaluation. [Journal of Gerontological Nursing, 44(1), 15-19.].

Challenges to Ethically Managing Parkinson Disease: An Interview Study of Patient Perspectives.

This study investigated the current ethical issues in relation to recognizing and managing Parkinson disease (PD) from the patient's perspective. METHODS: Twelve patients living with PD who were from the medical school's Patients as Educators program were recruited. Semistructured interviews were conducted to record patient experiences in order to identify potential ethical issues in relation to recognizing and managing PD. Thematic analysis was applied to the interview transcripts. RESULTS: Four key themes emerged from the interviews. These were information giving, coping, identity, and future medical treatment. These data indicate variable experiences in relation to communication between patient and health-care professional, better support for both planning end-of-life decisions and in coping with the disease's impacts on their identity. Patients with PD also struggle with access to support services and support for main carer. IMPLICATIONS: To ensure ethical practice in supporting patients with PD, these emerging themes need further investigation; and management guidelines relevant to PD must be informed by research in this area to ensure ethical care of patients with PD, their carers, and families.

Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game.

BACKGROUND: Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care. AIMS: This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings. METHODS: A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom's taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics. RESULTS: The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user-computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings. CONCLUSIONS: Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user-computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process.

A Serious Game for Teaching Nursing Students Clinical Reasoning and Decision-Making Skills.

The aim of this study was to design and pilot-test a serious game for teaching nursing students clinical reasoning and decision-making skills in caring for patients with chronic obstructive pulmonary disease. A video-based serious game prototype was developed. A purposeful sample of six participants tested and evaluated the prototype. Usability issues were identified regarding functionality and user-computer interface. However, overall the serious game was perceived to be useful, usable and likable to use.

Learning decision making through serious games.

BACKGROUND: In Serious Games (SGs), educational content is integrated into a game so that learning is intrinsic to play, thereby motivating players and improving engagement. SGs enable learning by developing situated understanding in users and by enabling players to practise safe clinical decision making; however, the use of SGs in medical education is not well established. AIMS: We aimed to design a game-based resource to teach clinical decision making to medical students, and to assess user perceptions of educational value, usability and the role for SGs in undergraduate training. METHODS: An SG focusing on the acute management of tachyarrhythmias was developed. Third- and fourth-year medical students at the medical school were invited to use and evaluate the game using questionnaires and focus groups. RESULTS: We invited 479 students, and 281 accessed the game. Only 47 students completed the questionnaire and 31 students participated in the focus groups. The data suggest that SGs: (1) can allow students to rehearse taking responsibility for decision making; (2) are fun and motivational; (3) have a role in revising and consolidating knowledge; and (4) could be formative assessment tools. Serious Games enable learning by developing situated understanding in users CONCLUSIONS: SGs could be employed as adjuvant learning resources to develop students' skills and knowledge. Further empirical research is required to assess the added value of games in medical education.

Student assistantships: bridging the gap between student and doctor.

In 2009, the General Medical Council UK (GMC) published its updated guidance on medical education for the UK medical schools - Tomorrow's Doctors 2009. The Council recommended that the UK medical schools introduce, for the first time, a clinical placement in which a senior medical student, "assisting a junior doctor and under supervision, undertakes most of the duties of an F1 doctor". In the UK, an F1 doctor is a postgraduation year 1 (PGY1) doctor. This new kind of placement was called a student assistantship. The recommendation was considered necessary because conventional UK clinical placements rarely provided medical students with opportunities to take responsibility for patients - even under supervision. This is in spite of good evidence that higher levels of learning, and the acquisition of essential clinical and nontechnical skills, depend on students participating in health care delivery and gradually assuming responsibility under supervision. This review discusses the gap between student and doctor, and the impact of the student assistantship policy. Early evaluation indicates substantial variation in the clarity of purpose, setting, length, and scope of existing assistantships. In particular, few models are explicit on the most critical issue: exactly how the student participates in care and how supervision is deployed to optimize learning and patient safety. Surveys indicate that these issues are central to students' perceptions of the assistantship. They know when they have experienced real responsibility and when they have not. This lack of clarity and variation has limited the impact of student assistantships. We also consider other important approaches to bridging the gap between student and doctor. These include supporting the development of the student as a whole person, commissioning and developing the right supervision, student-aligned curricula, and challenging the risk assumptions of health care providers.

A model of professional self-identity formation in student doctors and dentists: a mixed method study.

BACKGROUND: Professional self-identity [PSI] can be defined as the degree to which an individual identifies with his or her professional group. Several authors have called for a better understanding of the processes by which healthcare students develop their professional identities, and suggested helpful theoretical frameworks borrowed from the social science and psychology literature. However to our knowledge, there has been little empirical work examining these processes in actual healthcare students, and we are aware of no data driven description of PSI development in healthcare students. Here, we report a data driven model of PSI formation in healthcare students. METHODS: We interviewed 17 student doctors and dentists who had indicated, on a tracking questionnaire, the most substantial changes in their PSI. We analysed their perceptions of the experiences that had influenced their PSI, to develop a descriptive model. Both the primary coder and the secondary coder considered the data without reference to the existing literature; i.e. we used a bottom up approach rather than a top down approach. RESULTS: The results indicate that two overlapping frames of reference affect PSI formation: the students' self-perception and their perception of the professional role. They are 'learning' both; neither is static. Underpinning those two learning processes, the following key mechanisms operated: [1] When students are allowed to participate in the professional role they learn by trying out their knowledge and skill in the real world and finding out to what extent they work, and by trying to visualise themselves in the role. [2] When others acknowledge students as quasi-professionals they experience transference and may respond with counter-transference by changing to meet expectations or fulfil a prototype. [3] Students may also dry-run their professional role (i.e., independent practice of professional activities) in a safe setting when invited. CONCLUSIONS: Students' experiences, and their perceptions of those experiences, can be evaluated through a simple model that describes and organises the influences and mechanisms affecting PSI. This empirical model is discussed in the light of prevalent frameworks from the social science and psychology literature.

Differing perceptions among ethnic minority and Caucasian medical students which may affect their relative academic performance.

INTRODUCTION: Ethnic minority (EM) medical students in the United Kingdom underperform academically compared to their Caucasian counterparts, but the reasons are unclear and further understanding is required. AIM: To explore self-reported factors that might influence academic underperformance of EM medical students. METHOD: An online semi-structured questionnaire was used to identify associations between several dimensions that had been identified in previous research and obtain free-text comments. RESULTS: Three-hundred and fifty-one medical students (73.3% Caucasian and 26.5% EM) from the Universities of Sheffield, Keele and London responded. EM medical students were less satisfied with their academic performance and less likely to feel they belonged to the medical school community due to their cultural background, including socio-economic factors. CONCLUSION: Differences exist between EM and Caucasian medical students in their learning experiences in medical school. There is a need to increase awareness, for both medical students and teaching staff, of the impact of cultural diversity on academic performance at medical school.

FY1 doctors' ethicolegal challenges in their first year of clinical practice: an interview study.

BACKGROUND: There is little evidence of junior trainee perspectives in the design and implementation of medical ethics and law (MEL) curriculum in UK medical schools. AIM: To determine the ethical issues the foundation year 1 (FY1) doctors (first year after graduation)  encountered during clinical practice and the skills and knowledge of MEL, which were useful in informing MEL curriculum development. METHOD: The National Research Ethics Service gave ethical approval. Eighteen one-to-one interviews were conducted in each school with FY1 doctors. ANALYSIS: Interviews were recorded and transcribed verbatim; a thematic analysis was undertaken with the transcriptions and saturation of themes was achieved. KEY FINDINGS: Themes closely overlapped between the two study sites. (1) Knowing my place as an FY1 (this theme consisted of four subthemes: challenging the hierarchy, being honest when the team is titrating the truth, taking consent for unfamiliar procedures and personal safety vs competing considerations); (2) Do not attempt resuscitation)/end-of-life pathway and its implications; (3) 'You have to be there' (contextualising ethics and law teaching through cases or role plays to allow students to explore future work situations); and (4) advanced interpersonal skills competency for ethical clinical practice. CONCLUSIONS: The data provide a snapshot of the real challenges faced by MEL FY1 doctors in early clinical practice: they may feel ill-prepared and sometimes unsupported by senior members of the team. The key themes suggest areas for development of undergraduate and postgraduate MEL curricula. We will work to develop our own curriculum accordingly. We intend to further investigate the applicability of our findings to UK medical ethics and law curriculum.

Do assessor comments on a multi-source feedback instrument provide learner-centred feedback?

OBJECTIVES: Free-text comments in multi-source feedback are intended to facilitate change in the assessee's practice. This study was designed to utilise a large dataset of free-text comments obtained in a national pilot study in order to investigate how helpful these free-text comments may be to assessees. METHODS: We investigated: (i) which areas of performance are usually addressed by free-text comments; (ii) to what extent assessors' (doctors, nurses, allied health professionals and clerical or managerial staff) comments correspond to assessees' (career-grade doctors) self-assessments, and (iii) whether the comments contain specific behavioural evidence and suggestions for change. Initially comments were read through to identify commonly recurring themes. A strong theme was 'respondent-centredness', which refers to the extent to which comments focus on issues that are of value to the assessor rather than to the assessee's personal development. In response to this, the data were re-evaluated against predefined research questions to assess how constructive comments were for the assessee's personal development. RESULTS: Of 11,483 assessor forms, 4777 (42%) included free-text comments. A total of 513 forms contained at least one below average score and 286 (56%) of these forms contained the assessor's free-text feedback. Free-text comments were mostly rater-centred and addressed the effect of the assessee on the colleague's working life rather than areas of relevance to the assessee's personal development. A total of 1806 assessor/assessee pairs of comments were compared; most demonstrated clear differences of opinion or interpretation. Reliability and supportiveness were over-represented; clinical performance and personal development were under-represented. The comments were unlikely to provide specific behavioural evidence or to address how change might be initiated. CONCLUSIONS: Our data indicate that, in their current form, the overwhelming majority of free-text comments add little to facilitate improvement in assessees' personal development and performance.

Student doctors taking responsibility.

BACKGROUND: New guidelines require all undergraduate medical students to undertake at least one period of assistantship where they assume most of the responsibilities of a first-year graduate doctor (FY1 doctor in the UK) under supervision. AIM: To investigate the feasibility of these assistantships. METHOD: All UK schools were sent a questionnaire addressing the supervision required and the main barriers around implementation. RESULTS: Competencies that students already engage in as part of existing clinical placements and a number of 'tacit' competencies (e.g. practice and promote infection control) were regarded by most as suitable. Activities that present a clear clinical risk (e.g. prescribing and writing clinical correspondence) were regarded by most as unsuitable or requiring continuous supervision. Some lower risk but hard to measure activities (e.g. responding in practice to audit) were also regarded as unsuitable by some. A competency was usually considered inappropriate for one of three reasons: (1) current clinical governance and patient safety protocols appeared to bar students undertaking the competency; (2) a competency was not considered to be part of the current FY1 doctors' role; or (3) brief assistantships were considered unlikely to create sufficient opportunity for performing the competency. DISCUSSION: The article presents a number of practical issues in relation to assigning responsibility to student doctors. Respondents indicate that successful assistantships will only be possible if the UK National Health Service trusts review their attitude to balancing short- and long-term risks: assistantships need to be long enough to create genuine responsibility opportunities, and will require investment in supervision beyond the current capacity.