Mentorship in health professions education - an AMEE guide for mentors and mentees: AMEE Guide No. 167.

This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development expand, we argue that the traditional dyadic format of mentoring alone will not help mentees to maximise their professional growth. Newer formats of mentoring are discussed in detail and their advantages and disadvantages compared. We use a variety of theoretical concepts to anchor the practice of mentorship: self-focussed and other-focussed motives; psychological safety; personal interpretive framework; Daloz model for balancing support and challenge; zone of proximal development; communities of practice; and development along multiple layers of competence. Recommended strategies for effective mentoring are based on extensive review of literature, as well as combined professional mentoring experiences of the authors. We use key principles from the theories described and phases of mentoring relationships as foundations for the suggested best practices of mentorship. Finally, we emphasise the role of mentees in their own professional development and provide tips for them on seeking mentors, expanding their mentoring network and taking the lead in setting the agenda during mentoring meetings and formulating action plans for their own advancement.

An evaluation of the virtual simulated surgery assessment for the induction and return to practice scheme.

This paper reports on the development of the virtual Simulated Surgery assessment for the Induction and Return to practice (I&R) scheme and how it was used in the assessment of clinical and consultation skills. The evaluation examines the reliability and consistency of the virtual Simulated Surgery with the face-to-face assessment and reports feedback from the participants (candidates, administrators, marshals, examiners and role-players), highlighting what is lost and/or gained by the difference in format. Finally, the paper discusses the benefits and problems of remote assessment generally and looks at how this mode of assessment may be used in the future.

A review of the usefulness of clinical supervisor reports when writing educational supervisor reports.

In GP training, educational supervisors are responsible for collating evidence of a trainee's performance and progress to allow them to progress to the next stage of training. In hospital posts, they rely upon a clinical supervisor's report to help assess progress. Clinical supervisors are clinicians from various specialties who may not have an in-depth knowledge of the GP training programme, and anecdotally, our impression was that clinical supervisor reports were impersonal and not helpful in assessing a trainee's performance. We set out to evaluate the usefulness of a clinical supervisor's report in the context of completing and educational supervisor report for trainees in hospital posts. We reviewed clinical supervisor and educational supervisor reports for a cohort of 30 trainees in the Wessex Deanery, and conducted a questionnaire for their educational supervisors. All educational supervisors valued the clinical supervisor reports in completing their report, those with personal comments being the most useful. The majority of reports had a mixture of personal and generic comments. Overall, clinical supervisor reports provide additional information to evaluate performance, and they should continue to be used. To improve their use further, guidance can be given to clinical supervisors about the value of personal comments for trainees.

Tranexamic acid is safe to use following mild-to-moderate traumatic brain injury.

The studyThe CRASH-3 Trial Collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019;394:1713-23.This trial was funded by NIHR Health Technology Assessment Programme (project number 14/190/01), JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and the Wellcome Trust (Joint Global Health Trials scheme).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000870/tranexamic-acid-following-mild-to-moderate-traumatic-brain-injury-is-safe-and-reduces-deaths.

Planned earlier delivery for late pre-eclampsia may be better for mothers.

The studyChappell LC, Brocklehurst P, Green ME, et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019;394:1181-90.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/25/03).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000838/mothers-benefit-from-a-planned-earlier-delivery-for-late-pre-eclampsia.

Keyhole hysterectomy is effective for women with heavy menstrual bleeding.

The studyCooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019;394:1425-36.The study was funded by the NIHR Health Technology Assessment Programme (project number 12/35/23).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000837/keyhole-hysterectomy-is-effective-for-women-with-heavy-menstrual-bleeding.

GP Trainees experience of learning opportunities and support mechanisms on the GP training programme: a qualitative study.

This article was migrated. The article was marked as recommended. Background: General Practice (GP) is the cornerstone of the NHS and has faced workload and workforce issues for many years. Enabling GP trainees to successfully complete their training and become independent practitioners is crucial to addressing these challenges. There is limited previous research exploring the postgraduate training experience specific to General Practice. Aim: To explore GP Trainees' experience of learning opportunities and support available during the three-year vocational training programme in the Southampton GP Education Unit. Design and Setting: 15 semi structured interviews were undertaken December 2016-2018 with participants recruited from four cohorts. Telephone interviews lasting between 30-60 minutes were audio-recorded and transcribed verbatim; and analysed using inductive thematic analysis. Results and Conclusion: Two themes were identified as affecting the training experience: 'Developing clinical competence' and 'Sources of support'. Trainees perceived developing competencies relevant to General Practice was key. Busier hospital rotations with limited time for formal teaching were viewed less favourably. Trainers and peers were the main sources of support. Despite seeking a broad range of participants, interviewing trainees in difficulty was hard to achieve.

C reactive protein testing in general practice safely reduces antibiotic use for flare-ups of COPD.

The studyButler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med 2019;381:111-20.This research was funded by the NIHR Technology Assessment Programme (project number 12/33/12). The testing machines used in the study were loaned to researchers by the manufacturer, who also provided training on their use. The manufacturer had no other role in any part of the trial.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000820/crp-testing-safely-reduces-antibiotic-use-for-copd-flare-ups.

Does experience in general practice influence the clinical thinking of foundation trainees?

The aim of this exploratory study was to capture and identify changes in clinical thinking amongst foundation trainees after a four-month attachment in general practice, and to develop a means of analysing the data collected to inform understanding about how clinical thinking develops and changes for a trainee - the learner - in the context of clinical experience. We use the term 'clinical thinking' consistently throughout our paper to refer to the trainees' general thinking about a case, and do so in the same way as other academics. Through the innovative use of Mind Maps, we have sought to demonstrate whether there was a significant change in the themes and key features contained in maps drawn by foundation year 2 trainees before and after an attachment in general practice, and to locate the nature of the change if present. Being able to identify such change is potentially valuable as it can assist in revealing a trainee's learning needs and shape future learning.

Procedures and processes of accreditation for GP trainers: similarities and differences.

A survey of all UK deaneries was carried out to identify the processes and procedures associated with the approval of GP clinical and educational supervisors and to document the current similarities and difference between deaneries. The results of the survey were placed in the context of recent literature. Results showed notable variation in some areas as well as relatively recent developments becoming established practice, such as the requirement for a certificate of medical education. Overall, results indicate a time of transition and the potential for practice to be aligned across deaneries and local education and training boards (LETBs).

High fidelity trainee simulation to improve trainer performance.

BACKGROUND: Using trained actors to simulate trainee doctors in difficulty is a cost-effective communication skills teaching tool that can be enhanced by techniques that are familiar to hi-fidelity electronic simulation. Simulation has two broad strands: the first exchanges the patient for an actor in the clinical encounter, and the second introduces some form of technology to the encounter. The strand concerning actors is well developed, and generally focuses on 'the consultation'. Where simulation draws on technology, the spectrum is broad: it may be relatively low-tech, for example computer-based scenarios to test prescribing, through to more high-tech approaches to learning practical skills using sophisticated manikins that replicate patient signs and symptoms. Over the years simulation has radically changed medical training, and is set to continue to do so in the future. CONTEXT: Actors have been used for many years to contribute to the training and assessment of medical students, specialty trainees and established doctors. Their role to date has largely been limited to playing patients in scenarios. INNOVATION: This innovation in communication skills teaching seeks to draw on both strands of simulation. It sees actors playing general practice (GP) trainees to enhance the continuing professional development of established GP trainers, in contrast to the more usual use of actors playing patients. It also makes use of the control mechanisms afforded by technological simulation in fine-tuning role-play scenarios. IMPLICATIONS: By using actors, the scenarios can be played up or down in order to challenge participants and maximise their learning. More research is needed to develop this approach further in other medical education contexts.

Using actors to simulate doctors in the continuing professional development of GP trainers and appraisers.

Simulation has radically changed medical training and is set to continue to do so in the future. The branch of simulation that sees actors playing a role in training and assessment is long-established and well-developed. Typically actors have been used to play the role of patient. This innovation in communication skills teaching sees actors playing doctors (specifically GP trainees or GP appraisees), to enhance the continuing professional development of established GP trainers and appraisers. By using actors, scenarios drawing on typical encounters can be played up or down using techniques which are familiar to hi-fidelity electronic simulation. This flexibility enables the 'challenge' of the encounter to be tailored to the needs of the participants in order to maximise their learning. Feedback from participants at the workshops was positive, noting that the approach is both challenging and revealing of their own practice. More research is needed to develop this approach further and explore it's relevance to other areas of GP training and CPD.

The application process for general practitioner trainers in United Kingdom deaneries: similarities and differences.

A survey was undertaken of the application and reapplication forms used by all the UK deaneries for general practice (GP) specialty training. The aim of the survey was to identify similarities and differences between deaneries in terms of the content and nature of the information requested, and the relationship of that information to the Postgraduate Medical Education and Training Board's (PMETB) Quality Assurance Framework (QAF). The details requested on the application forms were compared to the guidance set out in Generic Standards for Training, in order to see if they reflected the areas and standards required by the PMETB for the quality assurance of medical education and training. Although many similar areas of information were requested in the application process, great variation was found across some items which were not attributable to regional or contextual differences. The survey also found that the majority of domains of Generic Standards for Training are not well covered in the paper application process. Although deaneries may view their application processes for trainer approval as robust, this paper makes a number of recommendations and argues for the development of a standardised form for the appointment of general practice specialty training (GPST) trainers across the UK, based upon the PMETB QAF.