Unexpected medical undergraduate simulation training (UMUST): can unexpected medical simulation scenarios help prepare medical students for the transition to foundation year doctor?

BACKGROUND: Preparing medical students with the skills necessary to deal with emergency situations as junior doctors can be challenging due to the complexities of creating authentic 'real life' experiences in artificial environments. The following paper is an evaluation of the UMUST (Unexpected Medical Undergraduate Simulation Training) project; a high-fidelity simulation based training programme designed to emulate the experience of dealing with medical emergencies for final year medical students preparing for practice as Foundation Year trainees. METHODS: Final year medical students from Liverpool University who undertake their clinical placements at Blackpool Teaching Hospitals NHS Foundation Trust and St. Helens & Knowsley Teaching Hospitals NHS Trust were randomly allocated into groups and took part in a series of four unexpected simulation based scenarios. At the beginning of the week in which the scenarios ran, participants were issued with a hospital bleep which they carried with them during their placement. At an unknown time to them, the participants were bleeped to attend a simulated emergency scenario, and on arrival to the Clinical Skills and Simulation facility, members of the education team undertook a standardised simulation scenario. Each session was recorded on video which the participants subsequently watched as part of a debriefing process. An assessment tool was developed to gauge whether the participants made progress in their learning over the course of the four sessions. Focus groups were held with the participants in order to evaluate their experience of the programme, and questionnaires were later distributed to all participants once they had begun working as a Foundation Year trainee. The questionnaires asked them how relevant UMUST was in preparing them for dealing with medical emergencies. RESULTS: The questionnaires and the focus groups clearly showed that the doctors felt like UMUST was very valuable in preparing them to work as junior doctors. They had enjoyed taking part in UMUST and thought was a realistic and useful part of their undergraduate training. CONCLUSIONS: The feedback from the focus groups and the subsequent questionnaires clearly demonstrate that participants felt the UMUST programme helped to prepare them as junior doctors in terms of dealing with emergency situations.

A comparison of self-perceived competencies of traditional and reformed curriculum graduates 6 years after graduation.

BACKGROUND: In 1996, the University of Liverpool reformed its medical course from a traditional lecture-based programme to an integrated, community based PBL curriculum based on the recommendations in Tomorrow's Doctors (General Medical Council, 1993). AIM: A project has been underway since 2000 to evaluate this change. METHODS: This article will summarize questionnaires which were distributed to the final two cohorts to graduate from the traditional curriculum with the first two cohorts to graduate from the reformed curriculum 6 years after graduation. The questionnaires asked the graduates about their preparation for the key skills required to work as doctors. RESULTS: There were significant differences between reformed and traditional curriculum graduates on nearly all the questionnaire variables. Reformed curriculum graduates felt significantly better prepared for undertaking practical procedures, working in a team, understanding evidence-based medicine. The traditional graduates felt better prepared in variables relating to basic sciences such as understanding disease processes. CONCLUSION: Reforming the curriculum can change the way graduates from the same medical school view their undergraduate education.

Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes: Protocol for a mixed-methods parallel-group randomised feasibility study.

BACKGROUND: The disease burden of diabetes can have wide-ranging implications on patients' psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated haemoglobin target-setting. This protocol describes a study to determine the feasibility of evaluating psychological outcomes when setting explicit glycated haemoglobin targets in people with diabetes. METHODS: This single-centre randomised feasibility study will follow a mixed-methods approach across four sub-studies. In sub-study A, eligible adults (aged 18 and over) with type 1 or type 2 diabetes will complete baseline validated psychometric questionnaires evaluating health-related quality of life (EuroQoL-5D-5L), diabetes-related distress (Problem Areas In Diabetes), self-care (Summary of Diabetes Self-Care Activities), well-being (Well-Being Quetionnaire-12) and diabetes-related psychosocial self-efficacy (Diabetes Empowerment Scale-Long Form). Participants will be randomised to receive explicit glycated haemoglobin intervention targets 5mmol/mol above or below current glycated haemoglobin readings. Rates of eligibility, recruitment, retention and questionnaire response rate will be measured. Psychometric outcomes will be re-evaluated 3-months post-intervention. Sub-studies B and C will use qualitative semi-structured interviews to evaluate experiences, views and opinions of diabetes patients and healthcare professionals in relation to the acceptability of study processes, the use of glycated haemoglobin targets, the impact of diabetes on psychological well-being and, in sub-study D, barriers to participation in diabetes research. DISCUSSION: This mixed-methods study aims to provide a novel insight into the psychological implications of glycated haemoglobin target-setting for people with diabetes in secondary care, alongside testing the feasibility of undertaking a larger project of this nature. TRIAL REGISTRATION: The study is registered with the ISRCTN (registration number: 12461724; date registered: 11th June 2021). Protocol version: 2.0.5, 26th February 2021.

The individualisation of glycaemic targets in response to patient characteristics in type 2 diabetes: a scoping review.

BACKGROUND: Evidence and guidelines increasingly support an individualised approach to care for people with type 2 diabetes and individualisation of glycaemic targets in response to patient factors. METHODS: We undertook a scoping review of the literature for evidence of factors impacting upon glycated haemoglobin target individualisation in adults with type 2 diabetes. Data were analysed thematically with the themes inductively derived from article review. FINDINGS: Evidence suggests that presence of cardiovascular disease, hypoglycaemia unawareness, severe hypoglycaemia, limited life expectancy, advanced age, long diabetes duration, frailty, cognitive impairment, disability, extensive comorbidity, diabetes distress and patient preference should inform the setting of glycaemic targets. CONCLUSION: The management of people with diabetes is complex. In clinical practice, many patients will have a variety of factors that should be considered when personalising their care. Approaches to personalised care and glycaemic treatment targets should be undertaken as part of a shared decision-making process between physician and patient. Use of electronic records might enable greater efficiency and more widespread use of personalised care plans for people with diabetes.

An evaluation of the impact of country of primary medical qualification on performance in the UK Royal College of Anaesthetists' examinations.

BACKGROUND: Many junior doctors from around the world come to the UK to train and attend professional examinations. AIM: This study summarises the performance of graduates by country of primary medical qualification in part one of the UK Royal College of Anaesthetists (RCA) examination from 1999 to 2008. METHODS: Data were collated from RCA spreadsheets for each attempt of the primary examination from June 1999 to May 2008 from the main RCA trainee database. Candidates were ranked into groups according to the country of primary medical qualification for the overall final percentage mark of the multiple choice question section of the Primary Fellowship of the Royal College of Anaesthetists examination. RESULTS: Candidates from Australia, New Zealand, South Africa, Zimbabwe and the UK performed significantly better than the mean for the group and candidates from Egypt, Iraq, Ireland and Pakistan performed significantly worse. CONCLUSION: Some graduates who sit UK postgraduate exams may require additional support prior to taking these examinations.

Higher Speciality Training Boot Camp in Otolaryngology: A Quantitative and Qualitative Analysis of the Northern National Formative Specialty Training 3 Induction Course.

Background Opportunities for new otolaryngology trainees to develop their skills as they embark on specialty training can be limited. Our facility hosted a national simulation-based boot camp for new otolaryngology trainees in the UK. This study aimed to assess the effectiveness of the boot camp in improving trainee confidence as they transitioned from core surgical training (CST) to higher specialty training (HST) in otolaryngology. Methodology We conducted a prospective study on the effectiveness of the boot camp on trainee induction. The boot camp included hands-on simulation, small group teaching and didactic lectures addressing technical skills in the fields of otology, laryngology, rhinology, facial plastics, and paediatrics, as well as non-technical skills involving human factors, simulated ward round, and cognitive simulation. The boot camp curriculum reflected the competencies expected by the Joint Committee of Surgical Training (JCST) at this level of training. Participants completed a pre- and post-course questionnaire addressing their self-confidence for the technical and non-technical skills they developed during the boot camp. All participants were invited to participate in an interview 12 months after the boot camp. Results A total of 27 new otolaryngology trainees (approximately half of all new otolaryngology trainees in the UK) participated in the boot camp. A significant increase in median confidence was observed for all technical and non-technical stations (p < 0.0001). The increase in confidence observed was similar for participants regardless of prior experience in otolaryngology. Five candidates were interviewed a year after the boot camp. Analysis of the transcripts generated distinct comments that were grouped into five key themes. Conclusions A simulation-based boot camp mapped to the JCST curriculum can increase the confidence of new otolaryngology Specialty Training 3 trainees during their transition from CST to HST. It can provide valuable and durable technical and non-technical skills to aid trainees in the clinic, theatre environment, and when on-call during their inaugural year of training.

Graduates from a reformed undergraduate medical curriculum based on Tomorrow's Doctors evaluate the effectiveness of their curriculum 6 years after graduation through interviews.

BACKGROUND: In 1996 Liverpool reformed its medical curriculum from a traditional lecture based course to a curriculum based on the recommendations in Tomorrow's Doctors. A project has been underway since 2000 to evaluate this change. This paper focuses on the views of graduates from that reformed curriculum 6 years after they had graduated. METHODS: Between 2007 and 2009 45 interviews took place with doctors from the first two cohorts to graduate from the reformed curriculum. RESULTS: The interviewees felt like they had been clinically well prepared to work as doctors and in particular had graduated with good clinical and communication skills and had a good knowledge of what the role of doctor entailed. They also felt they had good self directed learning and research skills. They did feel their basic science knowledge level was weaker than traditional graduates and perceived they had to work harder to pass postgraduate exams. Whilst many had enjoyed the curriculum and in particular the clinical skills resource centre and the clinical exposure of the final year including the "shadowing" and A & E attachment they would have liked more "structure" alongside the PBL when learning the basic sciences. CONCLUSION: According to the graduates themselves many of the aims of curriculum reform have been met by the reformed curriculum and they were well prepared clinically to work as doctors. However, further reforms may be needed to give confidence to science knowledge acquisition.

The challenge of conducting qualitative research to understand the factors that influence equity in medical education: A scoping review.

This article was migrated. The article was marked as recommended. Introduction There are national and international concerns about equity in basic and postgraduate medical education, especially about differential rates of access and attainment across groups of learners. Qualitative research has been increasingly used to understand the factors that influence equity but there are potential limitations to this understanding related to how the research has been conducted. The aim of the scoping review was to identify how qualitative research exploring the factors that influence equity in basic and postgraduate medical education has been conducted. The intention was to inform future research. Methods The electronic databases British Education Index, Campbell Library, CINAHL, Cochrane Library, EMBASE, ERIC, Google Scholar, Health Management Information Consortium (HMIC), MEDLINE, PsycINFO, Web of Science and medical education journals were searched to identify relevant published articles between 2008 and April 2019. Results Among 19,523 articles identified from the literature search, 72 full text articles were included in the review. Most studies had a focus on only one background characteristic and only two studies had a strengths-based focus on individuals. Recommendations for change was at the 'policy level' in ten studies and four studies had learner recommendations for change. No studies with a participatory approach were identified. Conclusion The approach to conducting previous qualitative research appears to limit greater understanding of the complexity of factors that influence equity. In response to this challenge, we recommend that future research widen the focus to consider the experiences and strengths of individual learners in addition to those identified by background characteristics. Future qualitative research is recommended to have a broad focus on both the 'policy level' and 'local level', especially from multiple perspectives. We also recommend greater collaboration of participants with researchers throughout the research process.

Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews.

BACKGROUND: In 1996 The University of Liverpool reformed its medical course from a traditional lecture-based course to an integrated PBL curriculum. A project has been underway since 2000 to evaluate this change. Part of this project has involved gathering retrospective views on the relevance of both types of undergraduate education according to graduates. This paper focuses on the views of traditional Liverpool graduates approximately 6 years after graduation. METHODS: From February 2006 to June 2006 interviews took place with 46 graduates from the last 2 cohorts to graduate from the traditional Liverpool curriculum. RESULTS: The graduates were generally happy with their undergraduate education although they did feel there were some flaws in their curriculum. They felt they had picked up good history and examination skills and were content with their exposure to different specialties on clinical attachments. They were also pleased with their basic science teaching as preparation for postgraduate exams, however many complained about the overload and irrelevance of many lectures in the early years of their course, particular in biochemistry. There were many different views about how they integrated this science teaching into understanding disease processes and many didn't feel it was made relevant to them at the time they learned it. Retrospectively, they felt that they hadn't been clinically well prepared for the role of working as junior doctor, particularly the practical aspects of the job nor had enough exposure to research skills. Although there was little communication skills training in their course they didn't feel they would have benefited from this training as they managed to pick up had the required skills on clinical attachments. CONCLUSION: These interviews offer a historical snapshot of the views of graduates from a traditional course before many courses were reformed. There was some conflict in the interviews about the doctors enjoying their undergraduate education but then saying that they didn't feel they received good preparation for working as a junior doctor. Although the graduates were happy with their undergraduate education these interviews do highlight some of the reasons why the traditional curriculum was reformed at Liverpool.

An evaluation of the performance in the UK Royal College of Anaesthetists primary examination by UK medical school and gender.

BACKGROUND: There has been comparatively little consideration of the impact that the changes to undergraduate curricula might have on postgraduate academic performance. This study compares the performance of graduates by UK medical school and gender in the Multiple Choice Question (MCQ) section of the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination. METHODS: Data from each sitting of the MCQ section of the primary FRCA examination from June 1999 to May 2008 were analysed for performance by medical school and gender. RESULTS: There were 4983 attempts at the MCQ part of the examination by 3303 graduates from the 19 United Kingdom medical schools. Using the standardised overall mark minus the pass mark graduates from five medical schools performed significantly better than the mean for the group and five schools performed significantly worse than the mean for the group. Males performed significantly better than females in all aspects of the MCQ - physiology, mean difference = 3.0% (95% CI 2.3, 3.7), p < 0.001; pharmacology, mean difference = 1.7% (95% CI 1.0, 2.3), p < 0.001; physics with clinical measurement, mean difference = 3.5% (95% CI 2.8, 4.1), p < 0.001; overall mark, mean difference = 2.7% (95% CI 2.1, 3.3), p < 0.001; and standardised overall mark minus the pass mark, mean difference = 2.5% (95% CI 1.9, 3.1), p < 0.001. Graduates from three medical schools that have undergone the change from Traditional to Problem Based Learning curricula did not show any change in performance in any aspects of the MCQ pre and post curriculum change. CONCLUSION: Graduates from each of the medical schools in the UK do show differences in performance in the MCQ section of the primary FRCA, but significant curriculum change does not lead to deterioration in post graduate examination performance. Whilst females now outnumber males taking the MCQ, they are not performing as well as the males.

Using questionnaires to determine whether medical graduates' career choice is determined by undergraduate or postgraduate experiences.

BACKGROUND: There has been increased interest in the factors influencing the career choice of doctors. Feminization of the medical workforce, changing health care needs, reform of training has ensured that this is an important issue for workforce planners and educationists. AIMS AND METHODS: Questionnaires were distributed to graduates from the University of Liverpool 5 years post graduation requesting the most important influences on career choice. RESULTS AND CONCLUSIONS: The majority of graduates felt their career choice was primarily dictated by their postgraduate experience. Graduates chose their career pathway for a number of reasons including specialties that would secure home-work balance, disenchantment with training programmes, and work experiences post graduation rather than their undergraduate clinical attachments.

Exploring the impact of feedback on prescribing error rates: a pilot study.

Background Prescribing errors are prevalent in hospital settings with feedback identified as one potential error reduction strategy. Hospital pharmacists work alongside prescribers at ward level and are credible facilitators of prescribing error feedback. A formalised programme of pharmacist-led prescribing error feedback was designed and implemented Objective To determine the impact of the feedback intervention on prescribing error rates. Method Prospective prescribing audits were undertaken at baseline for control (n = 11) and intervention group (n = 10) prescribers. The intervention group received pharmacist-led, individualised constructive feedback on their prescribing, whilst the control group continued with existing practice. Prescribing was re-audited following 3-months of the intervention. Data were analysed using chi-squared and independent t-tests. Results Error frequency (123/641 intervention and 121/649 control) was comparable between groups at baseline (p = 0.819) with significant differences (90/1677 intervention and 236/984 control) post intervention (p = <0.005). Prescribing error rates were lower in the intervention group (mean change of -11.5%) and higher in the control group (mean change of +5.9%) following the intervention, with a mean significant difference of 17.4% (SD 4.7, 95% CI, -27.3 to -7.6), t = -3.694, p < 0.05, between groups. Conclusion Pharmacist-led prescribing error feedback positively influences prescribing. This intervention shows promise for wider application in hospital settings to optimise patient safety.

Does a new integrated PBL curriculum with specific communication skills classes produce Pre Registration House Officers (PRHOs) with improved communication skills?

Over recent years communication skills training has played an increasingly important role in UK medical curricula. When The University of Liverpool reformed its medical curriculum in 1996 from a traditional lecture-based curriculum to an integrated problem-based learning curriculum formal communication skills training was introduced into the course. The paper deals with a comparison between PRHOs' ideas about communication competencies for PRHOs who did receive communication skills training and those involved in a traditional curriculum without formal communication training. This has involved distributing questionnaires to PRHOs and their educational supervisors, holding focus groups with PRHOs and interviewing educational supervisors. Data have been collected on the last cohort of the traditional curriculum and first cohort of the new curriculum to allow comparisons between cohorts. The PRHO questionnaires show that both cohorts feel they are good communicators but the focus groups show different reasons for this. The traditional graduates feel it is because doctors are 'natural communicators' and those skills can't be taught. The PBL graduates relate their communication skills to their undergraduate tuition and found they used these techniques when communicating as PRHOs. Both the questionnaires and interviews with the consultants demonstrate they feel the communication of PRHOs has significantly improved.

How competent do graduates feel to undertake the skills required by the General Medical Council?

The General Medical Council outlines the skills medical students are meant to learn as undergraduates. This article summarizes how competent some foundation year one doctors from one deanery felt to undertake these skills, what had prepared them and what they would like more training on.

An evaluation of medical students' views on the introduction of a community placement and its impact on their understanding of patients with disabilities.

BACKGROUND: In 2011 the third-year community course at the University of Liverpool was reorganised to have an emphasis on disability. The aim was to increase students' understanding of some of the issues surrounding disability and what this means to individual patients. The rotation consists of six full-day, small-group tutorial sessions, five days at a GP placement where, amongst other things, they have to perform a 'long case' clerking of two patients with disabilities, communication skills sessions and visits to community disability centres. METHODS: Five focus groups were arranged with a total of 42 students from the third year at the University of Liverpool asking them their views on the rotation and whether it had increased their understanding of this area. RESULTS: The students had enjoyed the placement and felt it had increased their understanding of the issues surrounding disability. Seeing patients in the community, time spent being taught by a GP and seeing patients with a GP were particularly well received. The centre visits in particular gave them an insight into people's lives and the fact they had to log cases of patients with disabilities helped to ensure the aims of the rotation were met. CONCLUSION: Overall the responses from the students were positive towards the block and the placement and they could see the value of a disability rotation based in the community.

An evaluation of the impact of an increase in community-based medical undergraduate education in a UK medical school.

BACKGROUND: In 1996 Liverpool University reformed its MBChB programme from a traditional course to a reformed curriculum based on the recommendations in Tomorrow's Doctors. Liverpool community-based undergraduate medical education increased significantly. METHODS: Research comprised questionnaires and interviews six years after graduation with the final two cohorts to graduate from the traditional curriculum and the first two cohorts to graduate from the reformed curriculum, to ascertain their views on their undergraduate medical education. Two of the questionnaire variables and some of the interview questions were directly related to their community-based undergraduate medical education. RESULTS: Reformed curriculum graduates felt better prepared for understanding the relationship between primary and hospital care than traditional graduates. This was statistically significant. When assessing the amount of GP teaching they received, 64% of the traditional graduates felt their GP teaching was less than 'about right' compared with only 8% of reformed curriculum graduates. During the interviews the traditional graduates were divided about whether there should have been more GP exposure in their course and many said they had little knowledge about the relationship between primary and secondary care. Generally, the reformed curriculum graduates thought it was beneficial to have a larger amount of community teaching and it was useful for developing clinical skills and they understood the relationship between primary and secondary care. CONCLUSION: An increase in exposure to community-based undergraduate medical education can change the way graduates perceive and understand general practice.

Medical students' views and understanding of a career in academic medicine.

Academic medicine is crucial to the advancement of health care with responsibilities in research, teaching and clinical practice. There have been problems recently recruiting for academic posts. This article illustrates medical students' views and understanding of a career in academic medicine.

Educational supervisors evaluate the preparedness of graduates from a reformed UK curriculum to work as pre-registration house officers (PRHOs): a qualitative study.

INTRODUCTION: In 1996 the University of Liverpool introduced an integrated problem-based learning (PBL) medical curriculum incorporating the recommendations of Tomorrow's Doctors. This paper investigates whether the PRHO (pre-registration house officer) educational supervisors who supervise Liverpool graduates believe that the reformed curriculum is producing house officers who have the competencies outlined by the General Medical Council. METHODS: Forty-one interviews were arranged with a sample of educational supervisors in the Mersey Deanery area to ascertain their views on the competencies of Liverpool PRHOs. The interviews were tape-recorded, transcribed and analysed. RESULTS: The supervisors felt that the PRHOs had been well prepared to work as PRHOs, and compared with traditional graduates they were actually better prepared for the job of PRHO. They saw the PRHOs as competent communicators with improved clinical skills, who had good attitudes, were aware of limitations, were team workers, good at history-taking and examination and had different approaches to finding information. There was a very confusing picture regarding basic knowledge, with some consultants expressing concerns, despite saying they had adequate knowledge to work as PRHOs. It emerged that there was little consensus about the knowledge base of the traditional or PBL graduates or what knowledge level was needed at this stage. DISCUSSION: Educational supervisors believe that the reformed curriculum in Liverpool is producing competent PRHOs who have been better prepared for the role of PRHO than previous graduates. It could be that uncertainty over knowledge base may be the price paid for reducing the factual burden and improving preparedness for professional practice.

Pre-registration house officers' views on studying under a reformed medical curriculum in the UK.

In 1996 the University of Liverpool introduced a new curriculum based on the recommendations published in Tomorrow's Doctors. This work examines how graduates of that course view their undergraduate curriculum and whether they consider it prepared them well for the pre-registration year. Five focus groups were arranged with a selection of graduates from the first cohort to graduate from the reformed curriculum in order to ascertain their views on the course and how it had prepared them to work as pre-registration house officers (PRHOs). The focus groups were tape-recorded, transcribed and analysed. The PRHOs felt they had been well prepared for the PRHO year, citing the clinical experience of the final year, communication skills classes and the Clinical Skills Resource Centre as having been particularly beneficial. There were concerns about their basic science knowledge base although this had not affected their ability to work as PRHOs. They had criticisms of the way part of their course had been structured but overall they were happy with the content of the course. A reformed medical curriculum in the UK can prepare graduates well to work as junior doctors and can take away some of the anxiety associated with graduation; therefore, to that extent curriculum reform has worked. However, anxiety about undertaking the role of junior doctor seems to have been replaced by anxiety about knowledge base, despite having adequate knowledge to work as PRHOs. Students undertaking a reformed curriculum are wary about being the first people to use their training in the workplace. This factor may need to be considered when further reforms are introduced.

Preregistration house officer skill and competency assessment through questionnaires.

In 1996 the University of Liverpool reformed its medical course from a very traditional lecture-based curriculum to an integrated problem-based learning curriculum. This article summarizes the results of questionnaires sent to both traditional and reformed curricula Liverpool graduates asking them to assess their competencies.