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Background: The outcome of assessments is determined by the standard-setting method used. There is a wide range of standard - setting methods and the two used most extensively in undergraduate medical education in the UK are the norm-reference and the criterion-reference methods. The aims of the study were to compare these two standard-setting methods for a multiple-choice question examination and to estimate the test-retest and inter-rater reliability of the modified Angoff method. Methods: The norm - reference method of standard -setting (mean minus 1 SD) was applied to the 'raw' scores of 78 4th-year medical students on a multiple-choice examination (MCQ). Two panels of raters also set the standard using the modified Angoff method for the same multiplechoice question paper on two occasions (6 months apart). We compared the pass/fail rates derived from the norm reference and the Angoff methods and also assessed the test-retest and inter-rater reliability of the modified Angoff method. Results: The pass rate with the norm-reference method was 85% (66/78) and that by the Angoff method was 100% (78 out of 78). The percentage agreement between Angoff method and normreference was 78% (95% CI 69% - 87%). The modified Angoff method had an inter-rater reliability of 0.81 - 0.82 and a test-retest reliability of 0.59-0.74. Conclusion: There were significant differences in the outcomes of these two standard-setting methods, as shown by the difference in the proportion of candidates that passed and failed the assessment. The modified Angoff method was found to have good inter-rater reliability and moderate test-retest reliability. [ABSTRACT FROM AUTHOR]

Background: People are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked ‘what is known about how and why concurrent healthcare delivery and professional experiential learning interact to generate outcomes, valued by patients, general practitioners and trainees, for patients with multimorbidity in primary care?' Methods: This realist synthesis is reported using RAMESES standards. Relationship-centred negotiation of needs-based learning and care was the primary outcome of interest. Healthcare, social science and educational literature were sought as evidence. Data extraction focused on context, mechanism and outcome configurations within studies and on data which might assist understanding and explain; i) these configurations; ii) the relationships between them and; iii) their role and place in evolving programme theories arising from data synthesis. Mind-mapping software and team meetings were used to aid interpretative analysis. Results: The final synthesis included 141 papers of which 34 contained models for workplace-based experiential learning and/or patient care. Models of experiential learning for practitioners and for patient engagement were congruent, frequently referencing theories of transformation and socio-cultural processes as mechanisms for improving clinical care. Key issues included the perceived impossibility of reconciling personalised concepts of success with measurability of clinical markers or adherence to guidelines, and the need for greater recognition of social dynamics between patients, GPs and trainees including the complexities of shared responsibilities. A model for considering the implications of concurrency for learning and healthcare delivery in the context of multimorbidity in primary care is proposed and supporting evidence is presented. Conclusions: This study is novel in considering empirical evidence from patients, GPs and trainees engaged in concurrent learning and healthcare delivery. The findings should inform future interventions designed to produce a medical workforce equipped to provide multimorbidity care. Trial registration: PROSPERO International prospective register of systematic reviews CRD42013003862 [ABSTRACT FROM AUTHOR]

The General Medical Council (GMC) provides a core curriculum for all medical degrees in the UK. However, these guidelines do not provide in-depth, specific learning outcomes for the various medical specialties. Recognising our ageing population, the British Geriatrics Society in 2013 published their own supplementary guidelines to encourage and further direct teaching on Gerontology and Geriatric Medicine in medical school curricula. Although teaching on Geriatric Medicine, a sub-discipline of Gerontology, has reassuringly increased in UK medical schools, there are convincing arguments for greater emphasis to be placed on the teaching of another sub-discipline: Social Gerontology. Considering the skills and knowledge likely to be gained from the teaching of Social Gerontology, in this paper we argue for the greater universal adoption of its teaching. This would help ensure that the doctors of tomorrow are better equipped to manage more successfully and holistically the growing cohort of older patients. [ABSTRACT FROM AUTHOR]

Background: The NICE guideline for Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition. Methods: A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum. Results: Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care. Conclusions: In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input. [ABSTRACT FROM AUTHOR]

Background: The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. Methods: The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. Results: The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants. Conclusions: The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme -- both trainers and trainees will be essential. [ABSTRACT FROM AUTHOR]

This paper analyses candidate performance in the three components of the MRCP(UK) examination to establish when they are most likely to pass. Using data from the 2010 and 2011 MRCP(UK) examinations, pass rates of candidates who gained their primary medical qualification (PMQ) in 2005 or later were analysed. Results from a total of 22,827 candidates were included in the study: 12,517 (54.8%) from Part 1, 5,545 (24.3%) from Part 2 written and 4,765 (20.9%) from the Part 2 practical assessment of clinical examination skills (PACES). The results show that candidates are more likely to pass Part 1 and Part 2 written 12-24 months after graduation and to pass Part 2 PACES 25-36 months after graduation. When we consider the training programme for physicians in the UK, successful candidates are likely to be in foundation programmes or early core or specialty training when they achieve success. At the moment, some candidates are dissuaded from taking the examination during their foundation programme, but our data show that their likelihood of success is highest during this period of training. The analysis also shows that for candidates who fail their first attempt, delaying their next attempt by one diet significantly increases the likelihood of them passing at their next attempt. [ABSTRACT FROM AUTHOR]

Medical training is a complex endeavour and analysing its quality is not a simple task. The accuracy of information, particularly of data gathered from trainees, will depend greatly on its source, on perceptions relating to confidentiality and on the uses to which the data are put. These factors should guide our choice of feedback instrument. In addition, in times of 'survey fatigue', we have a duty to be efficient. This paper discusses the piloting of the 'feedback on performance for trainers' tool for clinical supervisors of geriatric medicine trainees in the North Western Deanery. This tool is a multisource feedback instrument that can be used to gather information specifically on the perceived quality of clinical supervision. The tool's design takes into account opinions relating to confidentiality and content validity that have been expressed by trainees, trainers, educationalists and administrators. The tool is relatively easy and quick to use, taking about 10 min of trainee or trainer time. Administrative support is needed but the workload should not be onerous, especially if an on-line process can be developed. Strong evidence to support the validity of this instrument has been collected. The next step is the development and evaluation of the approach as an online process. [ABSTRACT FROM AUTHOR]

All physicians who are training young doctors of the future recognise the current challenge of doing this in the NHS. The recently published Temple Report documents the challenge and some of the solutions. For Kent, Surrey and Sussex (KSS) Deanery, one of the responses was to implement a new structure and process at local level -- the local faculty groups (LFGs) -- to ensure appropriate curriculum delivery. This paper sets out the history, structure and purpose of LFGs, describes what happens during a LFG meeting in both open and closed sessions and presents feedback of learning from two years in action across 11 acute trusts in the South East Coast (SEC) strategic health authority area. The experience of trainers in SEC is that the local faculty group structure and associated processes is one strand in the more effective delivery of education in the current NHS environment. [ABSTRACT FROM AUTHOR]

Following successful pilots in 2006, knowledgebased assessments for those engaged in specialty training have been developed and implemented in 11 medical specialties, by the Federation of Royal Colleges of Physicians in partnership with the specialist societies. Over 400 physicians have been involved in a project that has required recruitment and training of up to 25 question writers in each discipline, and the constitution of examining boards and standard setting advisory groups in each specialty. The assessments (now known as the specialty certificate examinations) are delivered by computer-based testing in centres throughout the UK and overseas. This paper analyses the outcome of 14 examination diets, sat by 948 candidates, of whom 72% were occupying UK numbered training posts. A total of 786 candidates sat the examination in the UK, 162 in overseas centres. Pass rates among UK trainees have generally exceeded 80%, with reliability coefficients well in excess of 0.8. [ABSTRACT FROM AUTHOR]

As a consequence of change in medical, educational and regulatory practice, MRCP(UK) successfully modified the international PACES examination in 2009. This brief paper explains the rationale for change and summarises the development and implementation process. [ABSTRACT FROM AUTHOR]

This paper outlines the development and evaluation of the utility of workplace-based assessments in highermedical training: case-based discussion (CbD); the acute care assessment tool (ACAT); audit assessment; teaching observation and patient survey (PS). The study population included trainees in higher medical training (ST3) from physician specialties in the UK. The pilot consisted of a prospective study of the use of the new assessments using local study coordinators (LSCs) and volunteer trainees. In total, 169 LSCs were recruited and 134 trainees returned at least one assessment. The endof- pilot questionnaire was returned by 44 assessors and 57 trainees. Questionnaire data and qualitative feedback were used to evaluate the validity, impact and feasibility of the new tools. For adequate reliability (co-efficient 0.7) a total of 12 CbDs; three ACATs and 16 PS raters are required. There was evidence for the validity and positive educational impact of all the tools. There were difficulties with the feasibility of the PS. [ABSTRACT FROM AUTHOR]

Background: There are ongoing concerns about the quality of care provision for allergy in primary care. Aims: To identify current training provision in allergy to GP trainees and to understand how this could be enhanced. Methods: A cross-sectional survey of GP Speciality Training (GPST) programme directors was undertaken. Programme directors of the 174 GPST schemes were sent an online questionnaire which was informed by the content of the Royal College of General Practitioners curriculum. Quantitative data were descriptively analysed and a thematic analysis was undertaken of free text responses. Results: We obtained responses from 146 directors representing 106 training programmes. Responses indicated that two-thirds (62%, 95% Cl 53.1 to 71.5) of programmes were providing at least some allergy training, with the remaining third stating that they either provided no training or were unsure. Overall, one-third (33%, 95% Cl 22.7 to 42.2) of programme directors believed that all the relevant allergy-related curriculum requirements were being met. Where provided, this training was believed to be best for organ-specific allergic disorders but was thought to be poorer for systemic allergic disorders, particularly food allergy where 67% (95% Cl 57.5 to 76.5) of respondents indicated that training was poor. There was considerable interest in increasing the allergy training provided, preferably through eLearning modules and problem-based learning materials supported by those with relevant specialist knowledge. Conclusions: This UK-wide survey has identified important gaps in the training of GP trainees in relation to allergy care. Addressing these gaps, particularly in the management of systemic allergic disorders, should help to improve delivery of primary care-based allergy care. [ABSTRACT FROM AUTHOR]

The language of rights has long permeated discussions about health care in Britain, but during the latter half of the 20th century, patients' rights achieved a level of unprecedented prominence. By the end of the 1980s, the language of entitlement appeared to have spread into many areas of the National Health Service: consent to treatment, access to information, and the ability to complain were all legally established patients' rights. Patient organizations played a critical role in both realizing these rights and in popularizing the discourse of rights in health care in Britain. "Rights talk," however, was not without its drawbacks, as it was unclear what kinds of rights were being exercised and whether these were held by patients, consumers, or citizens. [ABSTRACT FROM AUTHOR]

The ongoing debate on the re-articulation of the relationship between professions, the market and the state, pays increasing attention to the issue of professional identities and how these are reframed through processes such as socialization and training. The UK government’s Modernising Medical Careers programme (MMC), which introduces significant revisions to the structure, content and delivery of undergraduate and postgraduate doctor training, represents a recent example of an interruption of such processes within public sector professions. MMC strikes at the very heart of the medical profession by demystifying the process of forming, socializing and initiating new generations of professionals, and shifting the control over the processes and conditions of professional closure away from the profession itself. The article draws on the methodological and conceptual lens provided by Wright Mills’ ‘Vocabularies of motive’ (1940) to analyse medics’ reactions to recent reforms in medical education. [ABSTRACT FROM PUBLISHER]

In this article the author offers his views on how medical schools in Great Britain select doctors, what could be done to improve the process of selection, the qualities which are needed in a good doctor and his experience of working in Ghana. He believes that students who are totally absorbed in their studies to the exclusion of almost everything else are less likely to make good doctors. He also discusses a study on the dropping out from medical schools in Great Britain over a period of ten years (1990-2000), which suggests that drop-out rates increased during this period and concluded that the probability of dropping out of medical school is 20 percent lower for students with a parent who is a doctor.

The article discusses the importance of understanding ageing and the appropriate management of older patients. It highlights a study which examines the teaching methods and activities about ageing and geriatric medicine taught to medical undergraduates in Great Britain. The study found out the inadequate curriculum in ageing and geriatric medicine in the country which promoted the General Medical Council to publish new version of the geriatric medicine curriculum.

Background: Respiratory disease is a major cause of morbidity and mortality not only in the United Kingdom, but globally. A good understanding of respiratory disease and its treatment is essential for all medical graduates. As a result of changes in clinical practice, patients with some common respiratory illnesses are less often admitted to hospital, restricting the experience available to undergraduate students. Combined with a potential shortage of clinical teachers, this means that new methods of teaching need to be developed and appraised. The aim of this study was to establish whether a web-based package on the diagnosis of respiratory disease would be as effective and as acceptable to final year medical students as tutor-led methods of teaching the same material. Methods: 137 out of 315 final year undergraduate students in a single medical school volunteered to take part. Each received up to two hours of tutor-lead interactive, tutor-lead didactic or electronic, Web-based teaching on the accurate diagnosis and management of respiratory disease. Post teaching performance was assessed by multiple true/false questions and data interpretation exercises, whilst students' teaching preferences were assessed by questionnaire. Results: Despite a high knowledge baseline before the study, there was a small, but statistically significant increase in knowledge score after all forms of teaching. Similarly, data interpretation skills improved in all groups, irrespective of teaching format, Although paradoxically most students expressed a preference for interactive tutor-lead teaching, spirometry interpretation in those receiving web-based teaching improved significantly more ⊏p &3xoo3D; 0.041⊐ than in those in the interactive group. Conclusion: Web-based teaching is at least as good as other teaching formats, but we need to overcome students' reluctance to engage with this teaching method. [ABSTRACT FROM AUTHOR]

Background Undergraduate teaching in occupational medicine in UK medical schools is in decline. We developed a teaching programme for the new curriculum at our medical school, and then used student evaluation to tailor it to students' perceived learning needs.Aims To examine medical students' perception of a teaching session in occupational medicine after changes made in the light of earlier student evaluation, and in particular their views on the inclusion of a workplace visit.Methods Questionnaire evaluation feedback completed immediately after teaching sessions, triangulated with a student focus group session conducted by an external facilitator to explore what students valued most and least and why. Comparison of student evaluations before and after changes introduced in the light of student evaluations.Results Students' perception of the usefulness and relevance of the session significantly improved after the changes. Students consistently identified the use of case scenarios as helpful but demonstrated a dichotomy of opinion about the value of a workplace visit. Overall, students valued the brevity of the session that resulted from removing the workplace visit.Conclusions It is possible to enhance students' perception of the value of a teaching session by modifying the session in the light of student-based evaluation. [ABSTRACT FROM AUTHOR]

The article presents an interview with Charles Engel, visiting academic at the Center for Higher Education Studies, School of Lifelong Education and International Development, at the University of London, and visiting professor at the University of Manchester in England. Engel discussed his involvement with medical education. He also elaborated on how he become involved in the production of photographic and audiovisual records for clinical and teaching purposes. Engel concentrated on improving standardized recording for clinical comparisons of therapeutic or surgical interventions, simplified macrophotography of the skin and color cinematography, such as the first open heart operation performed in Great Britain. Engel talked what hindered the creation and maintenance of a medical curriculum at the end of the 20th century in Australia.

Context Increasing the use of effective smoking cessation aids could in principle have a substantial public health impact. The UK government has undertaken several major policy initiatives to try to increase usage of smoking cessation medicines. It is important to evaluate what effect, if any, these have had to inform future policy in the UK and internationally. Objective: This study used sales data to examine the impact of government initiatives to increase access to smoking cessation medicines. Design: Information about prescription and non-prescription sales (1999-2002) was obtained. Estimates of utilisation were compared with findings from the Office of National Statistics (ONS) omnibus surveys. The effects of policy initiatives (making the medicines reimbursable and making them available on general sale outside pharmacies) were assessed by means of time series analysis. In addition a new nicotine replacement therapy (NRT) product (a nicotine lozenge) was launched and the effect of this on total utilisation was assessed. Results: Making bupropion, and subsequently nicotine replacement therapy (NRT), reimbursable had a major impact in medication usage; the estimated increase in each case was more than 80 000 "treatment weeks" purchased per month. In addition, introduction of a nicotine lozenge increased total utilisation and did not detract from usage of other medicines. According to both the sales and the survey data, the proportion of smokers using medicines to aid smoking cessation more than doubled from 8-9% in 1999 to 17% in 2002. The ONS surveys showed no increase in the proportions of smokers making quit attempts and so the effects were solely on the proportions of quit attempts that were aided by medication. Conclusions: In the UK, making smoking cessation medicines reimbursable led to a large increase in utilisation. While the effect on smoking prevalence would be too small to be detected in national surveys it could have a substantial public health impact. [ABSTRACT FROM AUTHOR]

The article provides information on two people who changed the face of medical education in the 20th century. William Osler was dedicated to training young doctors and believed that medicine was an old art that must be absorbed in the new science. Although Abraham Flexner is not a doctor, he caused many U.S. medical schools to go on business. The ideas of Flexner prompted the British Medical Council to improve the subject matter of the medical curricula.

There is a pressing need for medical graduates to be fully prepared to take on the responsibilities of prescribing and to be able to respond to continual inevitable rapid changes in therapeutics. The curricula in UK medical schools were greatly influenced by Tomorrow's Doctors, published by the General Medical Council in 1993. This has recently been updated. While it highlights the management of disease and use of drugs as key learning objectives, it offers little specific guidance. In this document we expand on these broad statements, provide a view of how these learning objectives might be achieved, and identify the key elements of a core curriculum in prescribing and therapeutics. [ABSTRACT FROM AUTHOR]

The article focuses on the need for medical schools in Great Britain to teach the role of primary health care team in preventive medicine. Medical schools focus their training in hospitals leading them to ignore preventive medicine. The rise of technology in medicine reduces the role of the doctor in counseling. A primary health care team is important to preventive medicine as it serves as an interface between the health care system and the people.

Background: Little research has compared the profile, success, or specialty destinations of graduates entering UK medical schools via accelerated, 4-yr, standard 5-yr and 6-yr programmes. Four research questions directed this investigation:- What are the success rates for graduates entering graduate-entry vs. undergraduate medicine courses? How does the sociodemographic and educational profile differ between these two groups? Is success – in medical school and foundation training – dependent on prior degree, demographic factors, or aptitude test performance at selection? What specialty do graduate entry medicine students subsequently enter? Methods: The data from two cohorts of graduates entering medical school in 2007 and 2008 (n = 2761) in the UKMED (UK Medical Education Database) database were studied: 1445 taking 4-yr and 1150 taking 5-yr medicine courses, with smaller numbers following other programmes. Results: Completion rates for degree programmes were high at 95%, with no significant difference between programme types. 4-yr entrants were older, less likely to be from Asian communities, had lower HESA (Higher Education Statistics Agency) tariff scores, but higher UKCAT (UK Clinical Aptitude Test) and GAMSAT (Graduate Medical School Admissions Test) scores, than 5-yr entrants. Higher GAMSAT scores, black or minority ethnicity (BME), and younger age were independent predictors of successful completion of medical school. Foundation Programme (FPAS) selection measures (EPM – educational performance measure; SJT – situational judgment test) were positively associated with female sex, but negatively with black or minority ethnicity. Higher aptitude test scores were associated with EPM and SJT, GAMSAT with EPM, UKCAT with SJT. Prior degree subject, class of degree, HESA tariff, and type of medicine programme were not related to success. Conclusions: The type of medicine programme has little effect on graduate entrant completion, or EPM or SJT scores, despite differences in student profile. Aptitude test score has some predictive validity, as do sex, age and BME, but not prior degree subject or class. Further research is needed to disentangle the influences of BME. [ABSTRACT FROM AUTHOR]

The author talks about the availability of flexible working patterns for medical graduates in Great Britain. They will seek such programs to achieve a sensible balance between their personal and professional lives. The increase in flexible training opportunities has not been matched by an increase in these career-grade posts. The National Health Service must go far beyond the creation of part-time training and career posts to increase recruitment and retention of staff.