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Cardiopulmonary resuscitation (CPR) is a lifesaving emergency procedure. To increase survival rates, it is recommended to increase the number of high school students who know how to perform CPR. We have developed an immersive "Virtual Reality (VR) Resuscitation Training" to train the theoretical knowledge of CPR in which trainees must save the life of the patient in a virtual environment. This paper presents a randomized controlled study with a pre‐posttest design to explore whether a VR enhanced curriculum improves high school students' theoretical CPR knowledge. Forty students without previous CPR experience in the past year were randomly assigned to either the VR group or the standard group. The VR group had a significant higher increase of correct answers in comparison with the Standard group. More importantly, the gain in score on taking the correct sequence of CPR steps was significant favouring the VR‐enhanced protocol over the Standard protocol. Therefore, the use of a VR training for CPR training appears to be an effective learning method for non‐medical students and may be of great value skilling high school students in becoming adequate CPR providers. [ABSTRACT FROM AUTHOR]

This article explores the experiences of U.K. medical students with dyslexia, using an interpretive phenomenological approach. This project began with a review of the literature, highlighting a void of qualitative research. We then conducted a collaborative autoethnography. This paper forms the next stage in this series of research. We aimed to elicit meaning and understanding from the lived experiences of our participants. Eight U.K. junior doctors with dyslexia were interviewed over the telephone in an in-depth, unstructured manner. Audio recordings were transcribed verbatim and thematically analysed with the aid of a template analysis. Experiences of helplessness and hopelessness were common. These may be a result of a fear of stigmatization and personal feelings of inadequacy. They may also be fuelled by the incidents of bullying and belittling from other medical students that were reported. An important meta-theme was of fear and lack of understanding. A lack of pastoral support was also reported. Their experiences of medical school assessments are also reported. More may need to be done to educate teachers and clinical supervisors on dyslexia. [ABSTRACT FROM AUTHOR]

Introduction Many doctors, across grades and specialities, supervise or advise students and juniors undertaking elective placements. Electives form part of medical curricula on a worldwide scale. The Medical Schools Council ( MSC) Electives Committee in the UK identified a gap in the current literature in relation to provision of comprehensive recommendations for the design and management of undergraduate elective programmes. Electives afford many known benefits for medical and other health care students, but the context, and risks (impacting potentially on patient, public and student well-being) are usually different from those associated with 'home' clinical placements. Aim The aim is to share experiences and good practice within UK Medical Schools, and inform and inspire others involved with similar programmes across the globe. Method This paper reports the results of the formation of a sub-group to draft a set of recommendations, drawing on the reported experiences of academic elective leads across all UK schools, and including input from the MSC, and the student group Medsin (to capture the learner voice). The final document was the result of a national consultative process of four iterations. The end document was approved at school level, e.g. by curriculum committee, by each of the participating schools. Recommendations The recommendations consolidate the experiences of 30 participating UK medical schools. The consultation process generated 17 pre-departure recommendations, seven during elective recommendations, 11 post elective recommendations and a further four recommendations relating to infectious disease. Conclusion We believe developing elective programmes using collective recommendations will provide a basis for a safer and more structured approach to a medical elective without losing the uniqueness and creative experiences valued by participants. Issues relating to undergraduates leaving their home school to experience medicine in a new context or country replicate across sites, so many recommendations will be transferable internationally. [ABSTRACT FROM AUTHOR]

In the latest "Connections" article, Church and Brown use the concept of 'critical mass' to explain how stigma, lack of career pathways and prioritization of clinical seniority may discourage non‐practicing clinicians from becoming educationalists. [ABSTRACT FROM AUTHOR]

Context Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. Methods We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. Results The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. Conclusion Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this paper is to determine the influence of do not attempt cardiopulmonary resuscitation (DNACPR) orders and the Universal Form of Treatment Options (‘UFTO’: an alternative approach that contextualizes the resuscitation decision within an overall treatment plan) on nurses' decision making about a deteriorating patient. Methods: An online survey with a developing case scenario across three timeframes was used on 231 nurses from 10 National Health Service Trusts. Nurses were randomised into three groups: DNACPR, the UFTO and no‐form. Statements were pooled into four subcategories: Increasing Monitoring, Escalating Concern, Initiating Treatments and Comfort Measures. Results: Reported decisions were different across the three groups. Nurses in the DNACPR group agreed or strongly agreed to initiate fewer intense nursing interventions than the UFTO and no‐form groups (P < 0.001) overall and across subcategories of Increase Monitoring, Escalate Concern and Initiate Treatments (all P < 0.001). There was no difference between the UFTO and no‐form groups overall (P = 0.795) or in the subcategories. No difference in Comfort Measures were observed (P = 0.201) between the three groups. Conclusion: The presence of a DNACPR order appears to influence nurse decision making in a deteriorating patient vignette. Differences were not observed in the UFTO and no‐form group. The UFTO may improve the way nurses modulate their behaviours towards critically ill patients with DNACPR status. More hospitals should consider adopting an approach where the resuscitation decisions are contextualised within overall goals of care. [ABSTRACT FROM AUTHOR]

Sleep is a pillar of health, alongside adequate nutrition and exercise. Problems with sleep are common and often treatable. Twenty years ago, UK medical school education on sleep disorders had a median teaching time of 15 min; we investigate whether education on sleep disorders has improved. This is a cross‐sectional survey, including time spent on teaching sleep medicine, subtopics covered and forms of assessment. Thirty‐four medical degree courses in the UK were investigated via a questionnaire. We excluded responses not concerned with general undergraduate education (i.e. optional modules). Twenty‐five (74%) medical schools responded. Time spent teaching undergraduates sleep medicine was: median, 1.5 hr; mode, <1 hr; mean, 3.2 hr (SD = 2.6). Only two schools had a syllabus or core module (8%) and five (22%) were involved in sleep disorders research. Despite the above, half of the respondents thought provision was sufficient. Free‐text comments had recurring themes: sleep medicine is subsumed into other specialties, obstructive sleep apnea dominates teaching, knowledge of sleep disorders is optional, and there is inertia regarding change. A substantial minority of respondents were enthusiastic about improving provision. In conclusion, little has changed over 20 years: sleep medicine is neglected despite agreement on its importance for general health. Sleep research is the exception rather than the rule. Obstacles to change include views that "sleep is not a core topic" or "the curriculum is too crowded". However, there is enthusiasm for improvement. We recommend establishment of a sleep medicine curriculum. Without better teaching, doctors will remain ill‐equipped to recognize and treat these common conditions. [ABSTRACT FROM AUTHOR]

Razack compares the discourse of widening access in the UK and Australia, raising incisive questions about the nature of meritocracy and constructs of fairness in student selection. [ABSTRACT FROM AUTHOR]

Background: Inequity in assessment can lead to differential attainment. Degree classifications, such as 'Honours', are an assessment outcome used to differentiate students after graduation. However, there are no standardised criteria used to determine what constitutes these awards. Methods: We contacted all medical schools in the UK and collected data relating to classifications awarded, criteria used and percentage of students receiving classifications across the 5‐year period prior to the 2019/2020 academic year. Results: All 42 UK medical schools responded, and 36 universities provided usable data. Of these 36 universities, 30 (83%) awarded classifications above a 'Pass'. We identified four classifications above a 'Pass', and these were 'Commendation', 'Merit', 'Distinction' and 'Honours'. Sixteen (44%) universities awarded a single additional classification, and 14 (39%) universities awarded two or more. There was considerable variation in the criteria used by each university to award classifications. For example, 30 (67%) out of 45 classifications were dependent on all examined years, 9 (20%) for a combination of years and 6 (13%) for final year alone. Twenty‐five of 30 universities that awarded classifications provided data on the percentage of students awarded a classification, and a median of 15% of students received any type of classification from their university (range 5.3% to 38%). There was a wide range in the percentage of students awarded each classification type across the universities (e.g. Honours, range = 3.1%–24%). Conclusions: We demonstrate considerable variation in the way UK medical degree classifications are awarded—regarding terminology, criteria and percentage of students awarded classifications. We highlight that classifications are another form of inequity in medical education. There is a need to fully evaluate the value of hierarchical degree awards internationally as the consequential validity of these awards is understudied. Degree classifications may be another form of inequity in medical education given variation in terminology, criteria, and percentage of students awarded. Byrne et al. argue a need to better understand the consequential validity of these awards. [ABSTRACT FROM AUTHOR]

Background: A positive doctor‐patient relationship is a crucial part of high‐quality patient care. There is a general perception that it has been changing in recent years; however, there is a lack of evidence for this. Adapting to the changing doctor‐patient relationship has been identified as an important skill doctors of the future must possess. This study explores (1) multiple stakeholder perspectives on how the doctor‐patient relationship is changing and (2) in what ways medical graduates are prepared for working in this changing doctor‐patient relationship. Methods: We conducted a national qualitative study involving semi‐structured interviews with multiple stakeholders across the United Kingdom. Interviews lasting 45–60 minutes were conducted with 67 stakeholders including doctors in the first 2 years of practice (ECD's), patient representatives, supervisors, deans, medical educators and other health care professionals. The interviews were audiorecorded, transcribed, analysed, coded in NVivo and analysed thematically using a Thematic Framework Analysis approach. Results: The main ways the doctor‐patient relationship was perceived to be changing related to increased shared decision making and patients having increasing access to information. Communication, patient‐centred care and fostering empowerment, were the skills identified as being crucial for preparedness to work in the changing doctor‐patient relationship. Graduates were reported to be typically well‐prepared for the preconditions (communication and delivering patient‐centred care) of patient empowerment, but that more work is needed to achieve true patient empowerment. Conclusion: This study offers a conceptual advance by identifying how the doctor‐patient relationship is changing particularly around the 'patient‐as‐knowledge‐source' dimension. On the whole ECD's are well‐prepared for working in the changing doctor‐patient relationship with the exception of patient empowerment skills. Further research is now needed to provide an in‐depth understanding of patient empowerment that is shared among key stakeholders (particularly the patient perspective) and to underpin the design of educational interventions appropriate to career stage. Doctor‐patient relationships are changing as shared decision‐making and patient access to information increases. Here graduates are reported as being well prepared for patient‐centred care while more work is needed to achieve patient empowerment. [ABSTRACT FROM AUTHOR]

Background: Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Method: Semi‐structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Results: Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill‐equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Conclusion: Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition – a paradigm shift from the medical model. Key points: This qualitative study explores work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors.Doctors acknowledge nutrition as an important component of nutrition care but are ill‐equipped to support such care, identifying limitations to the systems that might support integrated care.Efforts to build the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition – a paradigm shift away from a traditional medical (treatment) model. [ABSTRACT FROM AUTHOR]

Context North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too. Objectives The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America. Methods A systematic review was conducted using search terms encompassing psychological distress amongst medical students. Ovid SP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; Psyc INFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools. Results The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety. Conclusions Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students. [ABSTRACT FROM AUTHOR]

Introduction: Increasingly, dental education is using digital strategies to deliver teaching; however, not all of these learning materials are engaging and effective. Aim: To evaluate the perception and knowledge retention of undergraduate dental students after using two different digital learning tools: quizzes and PDF. Methods: Thirty‐three students from a Dental School in the United Kingdom took part in the research. They received learning material derived from the Prosthodontic (Kennedy classification) or Paediatric dentistry content (Tooth classification). The same content was delivered in two different formats: quiz game (n = 17) and PDF file (n = 16). The PDF file had ten images and their classifications, whilst the quiz had the same images with a question about the classification, along with alternatives (single best answer). Results: All students gave similar performances on the knowledge assessment; however, their perception about the learning material differed. Students using quizzes (88%) agreed that they were fun and an interesting way of learning, while only 37.5% had this opinion about PDF material (p =.002). When using quizzes, learners were more motivated and confident. They would frequently recommend quizzes to other colleagues; however, the use of PDF was not suggested as frequently (p =.039). As a learning strategy, 100% of the students using quizzes wanted more of the same to study other dental subjects. This was not the case with the PDF format (p =.005). Conclusion: Despite quizzes and PDF files resulting in a similar understanding of dental subjects, learners prefer quizzes to supplement their studies. Educators should consider using this interactive digital tool to engage students, instead of PDF files. [ABSTRACT FROM AUTHOR]

Background: Patient involvement in psychiatry education is required by policy and has many benefits for students. Little research has focused on the impact on expert patients (EPs). Objective: This study aimed to explore the impact of involvement in psychiatry education on mental health patients. Design: A qualitative descriptive study using semistructured interviews was conducted in a psychiatry teaching unit in the East Midlands, UK. A purposive sample of 20 EPs involved in teaching was interviewed about the social and psychological impacts of involvement. Transcripts were analysed thematically and a coding scheme was developed. Results: Five themes were identified: shaping the doctors of the future—something worthwhile, challenging assumptions about mental health, recovery and transformation, vulnerability and support and expertise and power. Conclusion: These EPs benefitted from their experience of teaching. Involvement in psychiatry teaching may require putting oneself in a vulnerable position, but a supportive and open faculty team may mitigate this challenge. The Expert Patient Programme was seen as a way of helping to reduce the power difference between patients and doctors in the future. There is a need to examine the language that we use to talk about patient involvement as this may have implications for this power dynamic. The context and mechanisms that lead to the benefits described by participants should be studied so that these benefits may be generalized to other contexts. Patient Contribution: An EP was involved in the planning and ethical approval application process of the project and the drafting and approval of this manuscript. [ABSTRACT FROM AUTHOR]

Background: Trigger warnings—prior notification of topics so recipients may prepare for ensuing distress—are encountered widely in contemporary culture. Students at some universities have expressed expectations for trigger warnings. Medical education routinely exposes students to numerous potentially distressing topics. However, this topic remains understudied in medical education. Little is understood about educators' views or practice relating to warnings in the context of medical education. Methods: Twenty medical educators from a medical degree programme in the UK participated in a semi‐structured qualitative interview study, exploring medical educators' views and experiences of managing distressing situations and, specifically, their use of warnings. We analysed interview transcripts by thematic coding and identified themes. Results: Analysis identified themes relating to educators' conceptualisation of trigger warnings and rationale for use, concerns about the use of warnings and the critical purpose of medical school in ensuring preparedness for clinical practice. Participants shared that warnings were given to empower students in approaching distressing topics and to enable engagement with learning. Warnings acknowledged that some experiences would be distressing and normalised and signalled acceptability of emotional responses. Decisions to use warnings were influenced by the nature of content and, reactively, in response to experiences of student distress. Terminology regarding trigger warnings was interpreted varyingly by participants. A broad variety of topics were identified as potentially sensitive. A number of concerns were noted regarding the use of warnings. Discussion: Warnings alone did not fulfil educators' responsibility in supporting students' professional development, but may be a useful adjunct, signalling that self‐care is valued and should be prioritised. Despite frequent use of warnings, individual educator practice was shaped by varying rationale. A framework that addresses competing tensions of preventing distress and supporting professional development is needed as part of a trauma‐informed approach to medical education. Trigger warnings are demonstrated to have supported students' professional development by signalling the need to recognise emotional responses and manage wellbeing. [ABSTRACT FROM AUTHOR]

Driven by demand for high standards in university education, efforts have been made in the UK to address the perceived imbalance between teaching and research. However, teaching is still perceived by many as having less credibility and is attributed less importance. The purpose of our research was to explore how distinct types of academic job profiles ('research' or 'education' focused, or 'balanced') impact on biomedical scientists' perceptions of the lecturer role. Specifically, we investigated the experiences of biomedical scientists in 'post‐1990' medical schools, which are known for their commitment to excellence in both research and education. We conducted 22 face‐to‐face, semi‐structured interviews with biomedical scientists in five schools. Focusing on experiences of work, the interviews covered: 'motivations', 'role expectations', 'teaching', 'research' and 'career'. The recorded qualitative data were transcribed and then analysed thematically. Our results, offering an insight into the working lives of biomedical scientists in medical education, suggest that in settings with a dual emphasis on education and research, individuals on 'balanced' contracts can experience a strong pull between research and teaching. In addition to posing significant challenges with respect to workload management, this can impact profoundly on professional identity. In contrast to the balanced role, 'research' or 'education' focused roles appear to have clearer requirements, leading to higher employee satisfaction. We conclude that to assist the educational mission of Higher Education, attention should be paid to balanced contracts, to (a) ensure employee support, (b) mitigate against negative perceptions of teaching, and ultimately, (c) guard against staff attrition. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Supporting underrepresented groups in pursuing, applying and matriculating into medical education is a key issue in the field. In the United Kingdom, Gateway to Medicine programmes were created as a specific form of entry to medical education, to support diversification goals. Whilst well‐established, how these programmes are broadly designed and implemented, and how their functioning links to conceptual views of diversity, is not well described in the literature. Methods: This article explores relevant diversity‐related literature, including a specific review of all Gateway programmes. Findings: Key facets of diversity‐related work in medicine, including the distinction between 'widening participation' and 'widening access' are discussed. These distinctions frame the presentation of Gateway years; their selection process, structure and function are described. The purpose of these years is then discussed, with the lens of different discourses around diversity in medicine, to provide theoretical and practical considerations. Recommendations for how faculty can better explore diversity‐related issues are also provided. Conclusion: Gateway programmes may be effective, to some extent, in widening access to medical education, but require considerable resourcing to operate. Though heterogenous in nature, these programmes share common elements. However, discourses around the goals and purpose of this diversification vary based on individuals and institutions. These varied perspectives, as well as the societal and historical implications of diversity‐related work, are important for all clinical educators to understand with depth, and address directly, in order to reduce inequalities both within medical education and society at large. [ABSTRACT FROM AUTHOR]

Introduction: Globally, people with the academic and personal attributes to successfully study medicine experience disadvantages associated with sociodemographic factors. Governments have attempted to address this issue via macrolevel policies aimed at widening participation (WP) to medicine. These policies differ by country, suggesting much can be learned from examining and comparing international policy discourses of WP. Our question was: How are discourses of WP to higher and medical education positioned in the UK and Australia? Methods: A systematic search strategy was guided by five a priori themes inspired by United Nations Sustainability Goals (2015). Seventeen policy documents (UK n = 9, Australia n = 8) published between 2008 and 2018 were identified. Analysis involved two over‐arching, iterative stages: a document analysis then a Foucauldian critical discourse analysis, the latter with the aim of unveiling the power dynamics at play within policy‐related discourses. Results: Discourses of social mobility and individual responsibility within a meritocracy are still paramount in the UK. In contrast, the dominant discourse in Australia is social accountability in achieving equity and workforce diversity, prioritising affirmative action and community values. Similarities between the two countries in terms of WP policy and policy levers have changed over time, linked to the divergence of internal drivers for societal change. Both nations recognise tensions inherent in striving to achieve both local and global goals, but Australia appears to prioritise community values in working towards 'nation building' whereas in the UK the focus on individuality and meritocracy at times seems at odds with achieving parity for disadvantaged individuals. Discussion: WP policies and practices are situated and contextual so caution must be taken when extrapolating lessons from one context to another. The history of a country and the nature of marginalisation in that country must be scrutinised when trying to understand what drives WP policy. While the UK and Australia recognise tensions between local and global goals, Australia appears to prioritise community values and 'nation building' whereas UK discourses focus on social mobility and individual responsibility. [ABSTRACT FROM AUTHOR]

Due to increasing demands in the amount of content to be learned within a medical and health sciences curriculum, there are benefits towards exploring options for new and effective delivery modes. Augmented reality technology has the potential to enhance learning in physiology and anatomy, where students require a three‐dimensional knowledge of human organ systems and structures. This study aimed to assess the effectiveness of learning when an identical lesson was delivered through augmented reality using either the Microsoft HoloLens or a mobile handheld tablet device. Thirty‐eight pre‐clinical undergraduate participants completed a lesson detailing the physiology and anatomy of the brain. Pre‐ and post‐intervention tests were provided to evaluate acquired knowledge. After the activity, participants also completed a Likert‐style questionnaire to evaluate adverse health effects experienced and assess their perceptions of the module. There were no significant differences between test scores from lesson delivery in either the HoloLens or mobile‐based augmented reality. However, a significant increase was reported in dizziness when using the HoloLens (25% higher, n = 19, p =.04). No other adverse health effects, such as nausea, disorientation or fatigue were observed. Both modes were effective for learning, providing evidence to support educators and developers wishing to adopt an augmented reality method of delivery in health sciences and medicine. A video abstract of this article can be viewed at https://youtu.be/GSayCmopGZg Practitioner NotesWhat is already known about this topic Modern technology continues to disrupt the way we teach in higher education.Teaching through virtual and augmented reality has shown great benefit in enhancing learning and the student experience in health sciences and medicine.There is the potential for new and upcoming delivery modes to continue this trend, including the introduction of both mobile and head‐mounted display based augmented reality.What this study contributes Investigates the potential for augmented reality to be used as a teaching tool, and supports its implementation in tertiary education.Identifies that although slight dizziness was reported in some participants from using the HoloLens, this does not appear to impact learning or student perceptions of the technology.Presents the HoloLens and mobile‐based augmented reality as novel and evidence‐based methods of instruction in health sciences and medicine.Implications for practice and/or policy Augmented reality is an effective delivery mode which can enhance learning.Students consider augmented reality through both the HoloLens and mobile‐based devices to be enjoyable and engaging.This novel method of instruction is useful to supplement learning in a tertiary education programme. [ABSTRACT FROM AUTHOR]

The recent development of electronic logbooks with secure off-device data storage provides a rich resource for research. We present the largest analysis of anaesthetic logbooks to date, with data from 494,235 cases logged by 964 anaesthetists over a 4-year period. Our analysis describes and compares the annual case-load and supervision levels of different grades of anaesthetists across the UK and Republic of Ireland. We calculated the number of cases undertaken per year by grade (median (IQR [range]) core trainees = 388 (252-512 [52-1204]); specialist trainees = 344 (228-480 [52-1144]); and consultants = 328 (204-500 [52-1316]). Overall, the proportion of cases undertaken with direct consultant supervision was 56.7% and 41.6% for core trainees and specialist trainees, respectively. The proportion of supervised cases reduced out-of-hours, for both core trainees (day 93.5%, evening 86.3%, night 78.6%) and specialist trainees (day 81.0%, evening 67.7%, night 56.4%). [ABSTRACT FROM AUTHOR]

Aims: To develop and evaluate a feasible, authentic pharmacist‐led prescribing feedback intervention for doctors‐in‐training, to reduce prescribing errors. Methods: This was a mixed methods study. Sixteen postgraduate doctors‐in training, rotating though the surgical assessment unit of 1 UK hospital, were filmed taking a medication history with a patient and prescribing medications. Each doctor reviewed their video footage and made plans to improve their prescribing, supported by feedback from a pharmacist. Quantitative data in the form of prescribing error prevalence data were collected on 1 day per week before, during and after the intervention period (between November 2015 and March 2017). Qualitative data in the form of individual semi‐structured interviews were collected with a subset of participants, to evaluate their experience. Quantitative data were analysed using a statistical process chart and qualitative data were transcribed and analysed thematically. Results: During the data collection period, 923 patient drug charts were reviewed by pharmacists who identified 1219 prescribing errors overall. Implementation of this feedback approach was associated with a statistically significant reduction in the mean number of prescribing errors, from 19.0/d to 11.7/d (estimated to equate to 38% reduction; P < .0001). Pharmacist‐led video‐stimulated prescribing feedback was feasible and positively received by participants, who appreciated the reinforcement of good practice as well as the opportunity to reflect on and improve practice. Conclusions: Feedback to doctors‐in‐training tends to be infrequent and often negative, but this feasible feedback strategy significantly reduced prescribing errors and was well received by the target audience as a supportive developmental approach. [ABSTRACT FROM AUTHOR]

Aims: To investigate medical students' perspectives on the influence of their undergraduate course and the UK prescribing safety assessment (PSA) on the acquisition of practical prescribing skills. Methods: An online questionnaire comprising multiple choice and open‐ended questions was available to UK medical students in years 3, 4 and 5. Descriptive statistics and thematic analysis were completed. Results: In total, 1023 medical students from 25 UK medical schools responded: 22% (3rd year), 37% (4th year) and 41% (final year). A minority of medical students believed that their medical course prepared them sufficiently for practical prescribing (36.4%, n = 372, 95% confidence interval [CI] = 32–41%), 52.6%, of students thought that practical prescribing should be introduced into the curriculum earlier (n = 538, CI = 48–57%), and 73.7% reported that a more consistent approach to the teaching and learning of practical prescribing might be beneficial (n = 754, CI = 71–77%). An awareness of the national PSA was high (86.5%, n = 885), particularly amongst final year students (98.3%, n = 413, CI = 97–100%); 67.4% of all students (n = 690, CI = 64–71%) and 72.1% (n = 303) of final year students perceived that the PSA will improve or had improved their practical prescribing skills. Conclusions: The majority of medical students perceive that their undergraduate course does not adequately prepare them for practical prescribing. Many believe that there is some merit in introducing practical prescribing teaching earlier in the curriculum and medical schools adopting a more consistent approach. Among medical students, the PSA is thought to have a positive influence on prescribing skills learning. These data might be useful in developing a programme of study dedicated to practical prescribing. [ABSTRACT FROM AUTHOR]

Context: Literature published around a decade ago demonstrated that UK individuals from non‐traditional groups may not consider, or aspire to, medicine because of sociocultural barriers and instead may perceive medicine as 'not for the likes of me'. Since this time, the UK higher education landscape has undergone significant change, with an increased emphasis on student choice and widening access (WA) initiatives. Consequently, the present study looks anew at the perceptions of medicine held by school pupils from non‐traditional backgrounds to assess whether sociocultural factors remain a major barrier to medicine. Methods: Focus groups were conducted with 71 high‐achieving school pupils in their penultimate or final years (aged 16–18 years). Participants attended UK state‐funded schools engaged with medical school WA initiatives. Transcripts were analysed thematically using a data‐driven approach. Themes were then interpreted through the conceptual lens of the 'reflexive habitus', an adapted version of Bourdieu's classic concept. Results: Participants did not perceive that sociocultural differences would deter them from aspiring to, or pursuing, the career of their choice. Some participants identified their 'different' background as a strength to bring to medicine. They reported that intrinsic motivators (personal interest and fulfilment) were most important in their own career choices. When asked what they believed might have motivated current medical students for the career, participants debated the role of extrinsic motivators (high status and income) versus intrinsic ones. 'Hot knowledge' (social contacts) from within medicine helped some participants reconcile any clash in perceived values and better imagine themselves in the profession. Conclusions: These non‐traditional school pupils from schools engaged with WA initiatives appear to have embraced the belief that medicine is for anyone with the appropriate desire and ability, regardless of background. Furthermore, some pupils reported that some aspects of their 'difference' (diversity) could help enrich the workforce and patient care. Given the prevalence of widening access initiatives, the authors re‐visit the perspective of non‐traditional students to query how things have changed. [ABSTRACT FROM AUTHOR]

Context: Differential performance in postgraduate examinations between home medical graduates and those who qualified outside their country of practice is well recognised. This difference is especially marked in the practical component of the UK Membership of the Royal College of General Practitioners (MRCGP) examination. The potential causes of such disparities are not well understood. Methods: Data were available for 1874 international medical graduates who applied for general practice (GP) specialty training in the UK in 2008–2012. The primary outcome was performance in the Clinical Skills Assessment (CSA) OSCE component of the MRCGP. The main predictors were performance on a situational judgement test (SJT) and clinical problem‐solving test (CPST), a test of applied clinical knowledge, used in the selection for GP training. Data relating to demographic characteristics and English language fluency were also available. To better understand the relationship between the predictors, the selection measures and the outcome, a series of univariable and multivariable models were developed and tested, concluding with a structural equation model to explore causality. Results: The CSA rating was more strongly predicted by SJT scores (standardised beta, 0.26) than by performance on the CPST (standardised beta, 0.17). There was a relationship between English language fluency and CSA score that was mainly mediated via SJT performance. Conclusions: These findings demonstrate that performance on an SJT predicts performance in a high‐fidelity clinical simulation (the CSA) in international medical graduates. Although the constructs tested by SJTs are debated, and are likely to vary across settings, culturally appropriate knowledge of interpersonal competence is likely to be evaluated. Improving the confidence of doctors in this area through targeted educational interventions, rather than focusing on increased clinical knowledge, is likely to be more effective at reducing disparities observed in postgraduate examination performance. Thus, there are important implications for the design of specialty selection and licensing assessments globally. [ABSTRACT FROM AUTHOR]

Context: Twitter is a social media platform on which users post very brief messages that can be rapidly communicated across wide geographical areas and audiences. Many doctors use Twitter for personal as well as professional communications and networking. The #TipsForNewDocs hashtag is used on Twitter to give advice to newly qualified doctors as they commence their careers. This study explores the nature and focus of such advice. Methods: An analysis of Twitter activity containing the #TipsForNewDocs hashtag was performed using Symplur health care analytics software. Tweets sent during a peak 48‐hour period in 2016 (immediately preceding the first day of work for newly qualified UK doctors) were studied. The geographical locations and professional backgrounds of participants were categorised and the content of tweets was subjected to thematic analysis. During 1 and 2 August 2016, 661 unique #TipsForNewDocs tweets were posted. A total of 621 (94.0%) were posted by people in the UK; 522 (79.0%) were posted by doctors, and the remainder by allied health care professionals and patients. Results: The majority of included tweets focused on aspects of professional development, improving personal or professional knowledge, particularly tacit knowledge, and developing ‘know‐how’. These aspects of professional knowledge have previously been described as fundamental to professional education and training. However, a significant subset of tweets focused on accelerating socialisation into the profession, an essential step in joining a professional community. The tweets relating to socialisation were often humorous and colloquial in nature. Conclusions: Despite their brief and often jocular nature, #TipsForNewDocs tweets provided meaningful advice for newcomers to the profession, often focusing on tacit learning and professional socialisation. Hashtag‐driven enquiries can be a valuable and time‐efficient way of accessing and sharing tacitly held knowledge. Social media content analysis can provide valuable insights into key educational issues. [ABSTRACT FROM AUTHOR]

Context: Discrimination and harassment create a hostile environment with deleterious effects on student well‐being and education. In this study, we aimed to: (i) measure prevalences and types of discrimination and harassment in one UK medical school, and (ii) understand how and why students report them. Methods: The study used a mixed‐methods design. A medical school population survey of 1318 students was carried out in March 2014. Students were asked whether they had experienced, witnessed or reported discrimination or harassment and were given space for free‐text comments. Two focus group sessions were conducted to elicit information on types of harassment and the factors that influenced reporting. Proportions were analysed using the Wilson score method and associations tested using chi‐squared and regression analyses. Qualitative data were subjected to framework analysis. Degrees of convergence between data were analysed. Results: A total of 259 (19.7%) students responded to the survey. Most participants had experienced (63.3%, 95% confidence interval [CI]: 57.3–69.0) or witnessed (56.4%, 95% CI: 50.3–62.3) at least one type of discrimination or harassment. Stereotyping was the form most commonly witnessed (43.2%, 95% CI: 37.4–49.3). In the qualitative data, reports of inappropriate joking and invasion of personal space were common. Black and minority ethnic students had witnessed and religious students had experienced a greater lack of provision (χ2 = 4.73, p = 0.03 and χ2 = 4.38, p = 0.04, respectively). Non‐heterosexual students had experienced greater joking (χ2 = 3.99, p = 0.04). Students with disabilities had experienced more stereotyping (χ2 = 13.5, p < 0.01). Female students and students in clinical years had 2.6 (95% CI: 1.3–5.3) and 3.6 (95% CI: 1.9–7.0) greater odds, respectively, of experiencing or witnessing any type of discrimination or harassment. Seven of 140 survey respondents had reported incidents (5.0%, 95% CI: 2.4–10.0). Reporting was perceived as ineffective and as potentially victimising of the reporter. Conclusions: Harassment and discrimination are prevalent in this sample and associated with gender, ethnicity, sexuality, disability and year group. Reporting is rare and perceived as ineffective. These findings have informed local developments, future strategies and the development of a national prevention policy. [ABSTRACT FROM AUTHOR]

Context Doctors must be competent from their first day of practice if patients are to be safe. Medical students and new doctors are acutely aware of this, but describe being variably prepared. Objectives This study aimed to identify causal chains of the contextual factors and mechanisms that lead to a trainee being capable (or not) of completing tasks for the first time. Methods We studied three stages of transition: anticipation; lived experience, and post hoc reflection. In the anticipation stage, medical students kept logbooks and audio diaries and were interviewed. Consenting participants were followed into their first jobs as doctors, during which they made audio diaries to capture the lived experiences of transition. Reflection was captured using interviews and focus groups with other postgraduate trainee doctors. All materials were transcribed and references to first experiences ('firsts') were analysed through the lens of realist evaluation. Results A total of 32 medical students participated. Eleven participants were followed through the transition to the role of doctor. In addition, 70 postgraduate trainee doctors from three local hospitals who were graduates of 17 UK medical schools participated in 10 focus groups. We identified three categories of firsts (outcomes): firsts that were anticipated and deliberately prepared for in medical school; firsts for which total prior preparedness is not possible as a result of the step change in responsibility between the student and doctor identities, and firsts that represented experiences of failure. Helpful interventions in preparation (context) were opportunities for rehearsal and being given responsibility as a student in the clinical team. Building self-efficacy for tasks was an important mechanism. During transition, the key contextual factor was the provision of appropriate support from colleagues. Conclusions Transition is a step change in responsibility for which total preparedness is not achievable. This transition is experienced as a rite of passage when the newly qualified doctor first makes decisions alone. This study extends the existing literature by explaining the mechanisms involved in preparedness for firsts. [ABSTRACT FROM AUTHOR]

Objectives Although trainees and trainers find feedback interactions beneficial, difficulties in giving and receiving feedback are reported. Few studies have explored what drives trainees to seek feedback. This study explores how workplace-based assessments ( WBAs) influence the ways surgical trainees seek feedback and feedback interactions. Methods Utilising a template analysis approach, we conducted 10 focus groups with 42 surgical trainees from four regions across the UK. Data were independently coded by three researchers, incorporating three a priori themes identified from a previous quantitative study. Further themes emerged from exploration of these data. The final template, agreed by the three researchers, was applied to all focus group transcripts. The themes were linked in a diagrammatical form to allow critical exploration of the data. Results Trainees' perceptions of the purpose of WBA for learning or an assessment of learning, and their relationship with their trainer impacted upon how trainees chose to use WBA. Perceiving WBA as a test led trainees to 'play the game': seek positive and avoid negative feedback through WBA. Perceiving WBA as a chance to learn led trainees to seek negative feedback. Some trainees sought negative feedback outside WBA. Negative feedback was more important for changing practice compared with positive feedback, which enabled trainees to 'look good' but had less of an effect on changing clinical practice. The timing of feedback relative to WBA was also important, with immediate feedback being more beneficial for learning; however, delayed feedback was still sought using WBA. Discussion Trainees' perceptions of the purpose of WBA and their relationship with their trainer informed when they chose to seek feedback. Trainees who perceived WBA as a test were led to 'play the game' by seeking positive and avoiding negative feedback. Outside of WBA, trainees sought negative feedback, which was most important for change in practice. [ABSTRACT FROM AUTHOR]

Background Workplace-based assessments ( WPBAs) are widely used in postgraduate training programmes internationally. WPBAs can function as both an assessment and an educational tool. Although some WPBAs are a mandatory requirement of approved curricula (as in the UK), little previous research has explored the extent to which such assessments are associated with adverse outcomes in postgraduate training. The present study examines whether the assessment element of Multisource Feedback, Patient Satisfaction Questionnaire and Educational Supervisors Review ratings can indicate if a trainee is likely to experience difficulty in successfully completing their planned training programme (i.e. fail one of their licensing assessments or need additional training time). Methods Data were collected for trainees undergoing a General Practice specialty training placement in Health Education East Midlands ( UK). Multivariate analyses were used to examine the predictive validity of the WPBAs and the outcome measures ( n = 327 to 329) and t-tests to calculate whether there were significant differences in performance between trainees who received low versus high WPBA ratings ( t = 4.03 to 10.27, p < 0.01). Results Multisource Feedback, Patient Satisfaction Questionnaire and Educational Supervisor's Review ratings were significantly correlated with subsequent performance in licensing exams ( r = 0.14 to 0.47, p < 0.01), and in addition explained significant variance in the likelihood of requiring additional training time (15.6% to 25.6%, p < 0.01). Conclusions Based on the findings, we assert that Multisource Feedback, Patient Satisfaction Questionnaire and Educational Supervisor's Review ratings have validity for predicting performance during training and are thus a useful tool for identifying trainees who are more likely to experience difficulty and could benefit from early additional support. [ABSTRACT FROM AUTHOR]

Background Globalisation has implications for the next generation of doctors, and thus for medical education. Increasingly, global health is being taught in medical schools, although its incorporation into an already full curriculum presents challenges. Global health was introduced into the MBChB curriculum at the University of Aberdeen through a student-selected component ( SSC) as part of an existing medical humanities block. The Global Health and Humanities ( GHH) module was first delivered in the autumn of 2013 and will shortly enter its third year. Methods This student-led study used quantitative and qualitative methods to assess the module's appropriateness and effectiveness for strengthening learning on global health, consisting of online surveys for course participants and semi-structured interviews with faculty members. Results Integrating global health into the undergraduate medical curriculum by way of an SSC was regarded by teaching staff as an effective and realistic approach. A recognised strength of delivering global health as part of the medical humanities block was the opportunity to expose students to the social determinants of health through interdisciplinary teaching. Participating students all agreed that the learning approach strengthened both their knowledge of global health and a range of generic skills. Discussion SSCs are, by definition, self-selecting, and will have a tendency to attract students already with an interest in a topic - here global health. A wide range of learning opportunities is needed to integrate global health throughout medical curricula, and to reach all students. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Despite the widespread inclusion of consultation skills in undergraduate healthcare curricula, patient-doctor interactions are often an imparting of evidence or information rather than an exchange. Evidence-based practice may be further enhanced by increasing explicit understanding of decision-making processes used by healthcare professionals and patients. This exploratory investigation evaluated the impact of an educational intervention on understanding of decision-making processes and practice. The effect of session schedule was assessed to inform the future delivery strategy of such approaches. Methods Three groups of primary care health professionals (n = 85) completed questionnaires using Likert scales to assess strength of agreement with decision-making statements exploring four themes - Theory, Applied Theory, Practice and Joint Practice - preintervention and post-intervention. Responses were analysed, firstly to assess the impact of the intervention on understanding of decision-making processes and practice across all participants and then by group to determine the effect of session schedules on outcome measures. Results Overall agreement with the decision-making statements significantly increased after the learning set (Mean = -0.162, SD = 0.355); t(64) = -3.666, p < 0.001). Multivariate analysis on effect of session schedule only found significant interactions for the theme 'Joint Practice' with group (p < 0.025) and 3-way interaction of Group and Main role. (p < 0.048). No consistent positive impact of longer session schedule was found. Conclusion Participation in the learning sessions significantly improved self-reported understanding of decision-making processes and application to clinical practice. The extended learning sessions did not provide additional benefits over and above 2 half days or 1 whole day learning sessions. [ABSTRACT FROM AUTHOR]

The authors argue that Sen's 'capability approach' can be extended to gain a more effective understanding of the concept of 'fairness in selection' [ABSTRACT FROM AUTHOR]

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Context As doctors in all specialties are expected to undertake leadership within health care organisations, leadership development has become an inherent part of medical education. Whereas the leadership literature within medical education remains mostly focused on individual, hierarchical leadership, contemporary theory posits leadership as a group process, which should be distributed across all levels of health care organisation. This gap between theory and practice indicates that there is a need to understand what leadership and followership mean to medical trainees working in today's interprofessional health care workplace. Methods Epistemologically grounded in social constructionism, this research involved 19 individual and 11 group interviews with 65 UK medical trainees across all stages of training and a range of specialties. Semi-structured interviewing techniques were employed to capture medical trainees' conceptualisations of leadership and followership. Interviews were audiotaped, transcribed verbatim and analysed using thematic framework analysis to identify leadership and followership dimensions which were subsequently mapped onto leadership discourses found in the literature. Results Although diversity existed in terms of medical trainees' understandings of leadership and followership, unsophisticated conceptualisations focusing on individual behaviours, hierarchy and personality were commonplace in trainees' understandings. This indicated the dominance of an individualist discourse. Patterns in understandings across all stages of training and specialties, and whether definitions were solicited or unsolicited, illustrated that context heavily influenced trainees' conceptualisations of leadership and followership. Conclusions Our findings suggest that UK trainees typically hold traditional understandings of leadership and followership, which are clearly influenced by the organisational structures in which they work. Although education may change these understandings to some extent, changes in leadership practices to reflect contemporary theory are unlikely to be sustained if leadership experiences in the workplace continue to be based on individualist models. [ABSTRACT FROM AUTHOR]

An editorial is presented that discusses the quality of medical education research (MER) in Great Britain in relation to the Research Excellence Framework (REF). Topics discussed include the role of the REF in all British higher education and professional education research, the lack of education in social scientific methods for most medical researchers, and a call by the authors for more research collaboration between those in the medical field and those in the more general education field.

The author reflects on the tenure of John Ellis, who served as editor-in-chief of the periodical "Medical Education" for its first nine volumes. The article covers Ellis' editorials and how they commented on the state of medical education during the late 1960s and early 1970s. It goes on to note prominent topics from the journal's early issues such as clinical education, assessment, and comparative education.