Perceptions of faculty toward "social obligation" at an Indian medical school.

BACKGROUND: The World Health Organization has defined social accountability of medical schools as "…obligation to direct their education, research, and service activities toward addressing the priority health concerns of the community." The current study looked at the extent to which the concept was understood in an Indian medical school, exploring how faculty perceived and were involved in directing a response to the social obligation of their medical school. METHODS: Seventeen semi-structured audio-recorded interviews were conducted by purposive sampling of faculty from different disciplines. Interviews were transcribed and analyzed through a collaborative thematic approach to gain insight into faculty knowledge of the "obligation triad" of responsibility, responsiveness, and accountability; enablers and barriers in implementation; and understanding stakeholder roles. RESULTS: Faculty were unfamiliar with the terms and were unaware of the movement towards socially accountable schools. They were, however, sensitive to their responsibilities towards students and the community. Four major themes emerged: Perceptions of social obligation, awareness of social and cultural values, the role of partnerships, and moving toward a socially accountable model. DISCUSSION: Sensitizing students towards community needs, impact of cultural and socio-economic backgrounds, importance of contextual curriculum, and stakeholder roles were some of the challenges highlighted in developing a socially accountable medical school.

Establishing a postgraduate fellowship in humanitarian medicine - building capacity and ensuring sustainability for the health sector in the Rohingya Crisis.

The Postgraduate Fellowship for Migrant and Refugee Health (PGF) is a 13-week programme of training, mentorship and workplace-based assessment for junior doctors working in the Rohingya migrant camps of Bangladesh. To date, four cohorts of 25 doctors who work in Primary Health Centres run by Non-Governmental Organisations (NGOs) have completed the programme. The PGF was developed and delivered by Doctors Worldwide (DWW), a UK-based international charity which aims to improve the health of communities by working in partnership with international, national and grassroots organisations focusing on health access, health improvement and health emergencies. The doctors working in the camps carry a burden of responsibility often out of proportion to their training, experience and seniority. The isolated nature of the camp health facilities, the paucity of equipment, drugs and facilities and the lack of any senior mentorship mean that clinicians have had to learn new roles and responsibilities on the job. Doctors Worldwide recognised this unique challenge at the start of the crisis in the latter half of 2017 and since 2018 it has successfully run the PGF using an international community of content developers with travelling and local teaching and support.

Belongingness: a commentary.

Vivekananda-Schmidt and Sandars have carried out a scoping review of the literature in health professions education on belongingness. Whereas the literature suggests a strong role for this concept in student motivation and learning identity formation and in facilitating positive mental health, their work reveals a dearth of research in medical, and particularly in primary care education. We know that embedded contact with primary care learning environments increases the proportion of medical graduates who enter general practice training and it is likely this association is mediated, at least in part, by the opportunity to develop a sense of belonging in the primary care world. By looking closely at belongingness, might we derive practical applications for enhanced primary care teaching? Using the social learning model proposed by Wenger who developed a concept of 'modes of belonging' and the connection with learning, this commentary identifies ways in which primary care educators might think about belonging as they develop learning opportunities.

Values based practice: a framework for thinking with.

Values are those principles that govern behaviours, and values-based practice has been described as a theory and skills base for effective healthcare decision-making where different (and hence potentially conflicting) values are in play. The emphasis is on good process rather than pre-set right outcomes, aiming to achieve balanced decision-making. In this article we will consider the utility of this model by looking at leadership development, a current area of much interest and investment in healthcare. Copeland points out that 'values based leadership behaviors are styles with a moral, authentic and ethical dimension', important qualities in healthcare decision-making.

General practice is 'different': qualitative study of acculturation experiences of East Staffordshire general practice specialty trainees.

BACKGROUND: Undergraduate medical education and postgraduate foundation training are largely secondary care based. General practice trainees also spend nearly half of their training in hospital rotations. Little is known about factors that support effective transition into general practice specialty training or belongingness experiences throughout training. AIM: To explore the reported experiences of general practice trainee transition into general practice, training in hospital settings, and views of the future. METHOD: Semi-structured interviews with 18 purposively selected trainees plus observation and stakeholder discussions by a visiting Sri Lankan general practice trainee attending the vocational training scheme in a participant observer role. RESULTS: Mastering core skills of general practice, undergraduate and early experience in general practice during specialty training, and general practice trainer guidance and role modelling facilitated transition. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, and secondary care affiliative behaviours were adaptive strategies. Allocation to more general practice relevant duties was thought to create value within the hospital team. General practice trainees are thriving with the support of general practice trainers and colleagues, vocational training scheme, and good work/life balance. International graduates require additional support in specific areas. CONCLUSION: Adequate support towards transition into general practice and fostering belongingness in hospital settings is important due to the wider impact on training, patient care, and primary/secondary care integration. We propose a theoretical explanation based on Wenger's social learning model, which may have useful practical implications.

Developing your teaching style: increasing effectiveness in healthcare teaching.

This paper reports the first stage in the development of a tool, the Six Staffordshire Teaching Styles Questionnaire, designed to raise awareness in teachers about their teaching style. Effective teachers are adaptable and flexible in providing variety in their teaching activities, aiming to match their manipulation of the teaching and learning environment to the needs of the learner, but teachers should also know what type of activities they are most effective at delivering. Just as mismatched learning styles can cause dysfunctional learning situations, one of the causes of stress in teachers can be an incongruency between the type of activities they believe are effective, or feel they are good at carrying out, and external expectations of "good teaching".

Perspectives on clinical leadership: a qualitative study exploring the views of senior healthcare leaders in the UK.

INTRODUCTION: Clinicians are being asked to play a major role leading the NHS. While much is written on about clinical leadership, little research in the medical literature has examined perceptions of the term or mapped the perceived attributes required for success. OBJECTIVE: To capture the views of senior UK healthcare leaders regarding their perception of the term `clinical leadership' and the cultural backdrop in which it is being espoused. SETTING: UK Healthcare sector PARTICIPANTS: Senior UK Healthcare leaders METHODS: Twenty senior healthcare leaders including a former Health Minister, NHS Executives, NHS Strategic Health Authority, PCT and Acute Trust chief executives and medical directors, Medical Deans and other key actors in the UK medical leadership arena were interviewed between 2010 and 2011 using a semi-structured interview technique. Using grounded theory, themes were identified and subsequently analysed in an attempt to answer the broad questions posed. MAIN OUTCOME MEASURES: Not applicable for a qualitative research project RESULTS: A number of themes emerged from this qualitative study. First, there was evidence of changing attitudes among doctors, particularly trainees, towards becoming involved in clinical leadership. However, there was unease over the ambiguity of the term 'clinical leadership' and the implications for the future. There was, however, broad agreement as to the perceived attributes and skills required for success in healthcare leadership. CONCLUSIONS: Clinical leadership is often perceived to be doctor centric and 'Healthcare Leadership' may be a more inclusive term. An understanding of the historical medico-political context of the leadership debate is required by all healthcare leaders to fully understand the challenges of changing healthcare culture. Whilst the broad attributes deemed essential for success as a healthcare leaders are not new, significant effort and investment, including a physical Healthcare Academy, are required to best utilise and harmonise the breadth of leadership talent in the NHS.

Training and education in healthcare leadership: Is it time for a NHS healthcare academy?

In his report into Mid-Staffordshire NHS Foundation Trust, Robert Francis QC suggested the need for a physical NHS 'staff college' to support the strengthening of clinical leadership in the NHS. We present qualitative research data from a series of semistructured interviews with senior healthcare leaders in the UK that highlights their thoughts on the state of both clinician's managerial and leadership knowledge and training in the UK and the opportunities and challenges that a 'staff college' model would present using the UK Armed Forces Defence Academy as an existing public sector model. While progress has been made towards strengthening leadership and management training for NHS staff since this research was performed, this research suggests the need for a more inclusive, corporate, multi-disciplinary approach to delivery, pooling the existing expertise and ensuring a whole workforce approach to the corporate NHS agenda.

Supporting learners who are studying or training using a second language:preventing problems and maximising potential.

INTRODUCTION: This paper looks at the barriers to effective postgraduate study potentially experienced by learners in the United Kingdom if their first language is not English. As part of the internationalisation of higher education, we are seeing a welcome increase in students leaving their home country to study. This brings benefits to both home and visiting students as they learn more about each other and come to understand differences and build on aspects they have in common. However it also brings specific challenges of linguistic capability, differences in cultural expectations of the role of learners and teachers and in the understanding of the nature of postgraduate study. English medium higher education institutions worldwide are increasingly engaged in development of courses on English for academic purposes, or for academic writing. There is even a Journal of English for Academic Purposes, with co-editors from Hong Kong and the UK. Previous research has tended to concentrate on teacher-centred issues such as maintaining the integrity of assessments (including a focus on inadvertent plagiarism), practical aspects such as familiarity and expertise with information technology and more recently an understanding that acculturation has a part to play in maximising the success of students moving from one country's academic model to another. MATERIALS AND METHODS: This was a qualitative project during which students whose first language was not English were interviewed. Thirteen postgraduate students on a masters award in medical education were engaged in semi structured interviews to elicit their experiences, views and suggestions. RESULTS: Three themes emerged as important to the students in this study: understanding and being understood is not just due to the words we use; the nature of postgraduate study is not universal; and the need to maintain personal identity.