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Workplace-based assessments (WPBAs) in postgraduate training may not always provide an accurate representation of a trainee's capability to perform a given task, or a true measure of a trainee's overall competence in clinical practice settings. This article describes how trainers can use a theory-driven and evidence-based intervention called dynamic assessment for providing an individual with the best opportunity to demonstrate a more accurate representation of their performance, and ultimately present the best version of themselves when undergoing an observed WPBA, such as a Direct Observation of Procedural Skills (DOPS) or Mini Consultation Evaluation Exercise (MiniCEX). Dynamic assessment simultaneously combines educational support with assessment as the trainee undergoes the WPBA by using focussed questions as prompts to facilitate an individual trainee's essential coordination of their motivational and thinking processes since this is often challenged during assessments. In addition, the response to the prompts can also provide trainers with information to inform specific feedback for future professional development.

Introduction: The development of clinical skills requires the appropriate use of self-regulated learning (SRL). Students' use of key SRL processes as they perform a clinical skill can be identified by SRL microanalysis and used to provide feedback. SRL-microanalysis feedback only on students' key SRL processes has not been previously researched for developing clinical skills. The aim of this study was to investigate whether SRL-microanalysis feedback only on students' key SRL processes can improve both their use of SRL and their clinical skill performance., Methods: Twenty-three final year medical students with no experience in the clinical skill required for mechanical ventilation participated in this study. Key SRL processes and clinical skill performance were measured before and after SRL microanalysis feedback., Results: Overall, we found an improvement in the key SRL processes of planning and monitoring of performance, with a significant difference in monitoring. We also found an increase in students' clinical skill performance., Discussion: This study, which is the first in clinical skills, demonstrated that SRL microanalysis feedback only on key SRL processes can improve both students' SRL and their clinical skill performance. studies are recommended with a great number of students and across a variety of clinical skills.

Clinical reasoning is fundamental for effective clinical practice. Traditional consultation models for teaching clinical reasoning or conventional approaches for teaching students how to make a diagnosis or management plan that rely on learning through observation only, are increasingly recognised as insufficient. There are also many challenges to supporting learners in developing clinical reasoning over time as well as across different clinical presentations and contexts. These challenges are compounded by the differences in how experts and novices make sense of clinical information, and the different cognitive processes each use when processing and communicating this information using precise medical language. Diagnostic errors may be due to cognitive biases but also, in a majority of cases, due to a lack of clinical knowledge. Therefore, effective educational strategies to develop clinical reasoning include identifying learners' knowledge gaps, using worked examples to prevent cognitive overload, promoting the use of key features and practising the construction of accurate problem representations. Deliberate reflection on diagnostic justification is also recommended, and overall, contributes to a growing number of evidence-based and theory-driven educational interventions for reducing diagnostic errors and improving patient care.

Problem: Doctors experience a range of negative reactions when managing acutely unwell patients. These may manifest as emotions or behaviors. Without appropriate coping strategies, these emotions and behaviors can impede optimal clinical performance, which directly affects patient care. Athletes use performance enhancing routines (PERs) to minimize the effect of their negative emotions and behaviors on competitive performance. The authors investigated whether PERs could similarly improve recently qualified doctors' emotional and behavioral control while managing acutely unwell patients and whether the doctors perceived any effect on clinical performance., Approach: Twelve doctors within 2 years of graduation from medical school recruited from 2 sites in Sheffield and Chesterfield, United Kingdom, implemented PERs using the PERFORM (Performance Enhancing Routines For Optimization of Readiness using Metacognition) model over a 4-month period between April and December 2017. The doctors' perceptions of PERFORM's effect on their ability to manage patients was evaluated using self-reported mixed-methods data, including think-aloud commentaries, semistructured interviews, and self-efficacy scores., Outcomes: Doctors reported that PERFORM improved their ability to control negative emotions or behaviors during an acutely unwell patient in situ simulation, showing a statistically significant improvement in self-efficacy scores (P = .003, effect size = 0.89). Qualitative data revealed perceived improvement in aspects of clinical performance such as enhanced knowledge recall and decision making. These performance attributes appeared to positively impact interprofessional relationships and patient care. Doctors individualized their PERs and supported the wider implementation of PERFORM in health care education., Next Steps: This is the first study to employ individualized PERs based on sports psychology in a medical context. The PERFORM model could be introduced into existing acute patient management courses to provide emotional regulation coaching alongside clinical skills training. Further research might investigate PERFORM's effect in other environments where emotional and behavioral control is paramount, such as surgery., (Copyright © 2020 by the Association of American Medical Colleges.)

Introduction: Medical school graduates in the UK consistently report feeling underprepared for the task of prescribing when embarking on practice. The effective application of self-regulated learning (SRL) approaches and feedback on complex tasks are associated with improved outcomes in practice-based clinical skills. Aims : This study aimed to investigate the effectiveness of an educational intervention using SRL-enhanced video feedback for improving the prescribing competency of junior doctors. Methods: A prospective cohort study was designed to compare intervention and control cohorts of junior doctors undertaking simulated clinical encounters at the beginning and end of their 4-month rotation through renal medicine. Results: The improvement in prescribing competency for the intervention cohort was significant ( p  < 0.001) with large effect size ( d  = 1.42). Self-efficacy improved in both cohorts with large (control cohort p = 0.026, r = 0.64) and medium (intervention cohort p = 0.083, d = 0.55) effect sizes. Goal setting and self-monitoring skills improved in the intervention cohort only with medium effect size ( p  = 0.096, d  = 0.53). Conclusions: SRL-enhanced video feedback is effective for improving prescribing competency and developing SRL processes such as goal setting and self-monitoring skills in simulated clinical encounters. Further research is required to evaluate transferability to other clinical sub-speciality contexts and investigate the effectiveness of the intervention for improving prescribing in non-simulated settings.

Background: The 'cannot intubate cannot oxygenate' (CICO) emergency requires urgent front of neck airway (FONA) access to prevent death. In cases reported to the 4th National Audit Project, the most successful FONA was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA. Consultant anaesthetists, head and neck surgeons, and general surgeons were compared in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons., Methods: We recruited 15 consultants from each specialty (total of 45) at a single tertiary care hospital in the UK. All agreed to participate in an in situ high-fidelity simulation of an 'anaesthetic emergency'. Participants were not told in advance that this would be a CICO scenario., Results: There were no significant differences in total time to successful ventilation between anaesthetists, head and neck surgeons and general surgeons (median 86 vs 98 vs 126 s, respectively, P=0.078). Anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs 86 s, P=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed 'surgeons' best placed to perform emergency surgical FONA in a genuine CICO situation., Conclusion: Anaesthetists regularly trained in emergency surgical FONA function at levels comparable with head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency., (Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

The undergraduate nursing degree in the UK comprises both theoretical and practical elements with the practical component being a large and important aspect. Within the clinical environment students learn to become a nurse by gaining membership of a community of practice and learning the technicalities of nursing. As the future of health and social care looks set to see unprecedented changes, contemporary nursing practice will demand that nurse graduates are equipped with advanced knowledge and skills. By doing so, graduate nurses will go on to provide high quality care within this changing context. The aim of the research was to explore student nurse perceptions of knowledge development and consolidation in a clinical practice environment by utilising a community of practice theoretical framework to question whether the clinical community of practice prepares student nurses for contemporary nursing practice. Four themes emerged from the research: establishing a place in the community, shaping identity, initiating learning opportunities, preparation for future practice. The findings suggest that the clinical community of practice provides an opportunity for students to both learn the technicalities of nursing and develop their professional identity. However, whilst the learning environment may be functional in maintaining current practice, it may not facilitate the learning required for contemporary nursing practice., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Pre-registration nursing programmes aim to prepare students to function effectively within an environment that provides front-line health care, with the over-riding concern being patient safety. Exhibiting the ability to assess practice-based situations and make decisions is critical to demonstrating effective clinical, professional and leadership competence., Aim: This small scale qualitative study explores first year student nurses' understanding of the importance of recording achievement of practice competence and identifying the factors which influence them when prioritising completion of their Practice Assessment Record. Participants were drawn from a University in the North West of England, UK., Method: Designed as an exploratory study inspired by a phenomenological approach. Data was collected through interviews and analysed using Colaizzi's approach to qualitative thematic analysis., Results: Participants experienced wide variation in learning opportunities, availability of mentors and mentor engagement in the assessment process. Some levels of resistance from mentors are unavoidably influenced by clinically orientated priorities which is not always fully appreciated by first year student nurses. Two themes: Unwarranted Variation and Unknowingly Ill-informed, revealed that the importance of practice learning experiences, the acquisition of competence and the subsequent recording of those achievements was understood by students, but not always by mentors., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

The intention of personalized teaching and learning to improve clinical performance is the optimization of individual performance across a variety of tasks in different environments. Educational interventions need to have a focus on the assessment and feedback of both outcome and process of performance. An essential component of the assessment and feedback on the process of performance is how 'the will' and 'the skill' are dynamically adapted by the individual through self-regulated learning processes. Microanalysis can identify the key self-regulated learning processes and the findings used to inform self-regulated learning enhanced feedback for personalized teaching and learning. The experience of the authors in using self-regulated learning enhanced feedback for optimizing performance in prescribing by junior doctors is discussed.

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

Medical Educators face an ongoing challenge in optimizing preparedness for practice for newly qualified doctors. Junior doctors have highlighted specific areas in which they do not feel adequately equipped to undertake their duties, including managing the acutely unwell patient. In these highly stressful, time-critical scenarios it might be assumed that a lack of knowledge underpins these feelings of apprehension from junior medics; however, having studied, trained and passed examinations to demonstrate such knowledge, perhaps other factors should be considered. The recent Olympic Games in Rio demonstrated the impact of sport psychology techniques in allowing athletes to achieve their optimum performance in the face of adversity. The use of mental and behavioral strategies to control feelings of anxiety and low self-efficacy are pivotal for athletes to deliver their best performance under extreme pressure. We consider whether such techniques could improve the preparedness of the newest recruits to the healthcare system, and the impact this could have on patient care. Finally, suggestions for potential research directions within this area are offered to stimulate interest amongst the research community.

Integrity, trust and authenticity are essential characteristics of an effective leader, demonstrated through a values-based approach to leadership. This article explores whether Covey's (1989) principle-centred leadership model is a useful approach to developing doctors' leadership qualities and skills.

Clinical learning experiences are an essential part of nurse education programs. Numerous approaches to clinical education and student supervision exist. The aim of this integrative review was to explore how studies have compared or contrasted different models of undergraduate nurse clinical education. A search of eight databases was undertaken to identify peer-reviewed literature published between 2006 and 2015. Eighteen studies met the inclusion criteria. A diverse range of methodologies and data collection methods were represented, which primarily explored student experiences or perceptions. The main models of undergraduate nurse clinical education identified were: traditional or clinical facilitator model; the preceptorship or mentoring model; and the collaborative education unit model in addition to several novel alternatives. Various limitations and strengths were identified for each model with no single optimal model evident. Thematic synthesis identified four common elements across the models: the centrality of relationships; the need for consistency and continuity; the potential for variety of models; and the viability/sustainability of the model. The results indicate that effective implementation and key elements within a model may be more important than the overarching concept of any given model. Further research is warranted to achieve an agreed taxonomy and relate model elements to professional competence., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

There is limited evidence to underpin the assessment and management of pain in children with profound cognitive impairment and these children are vulnerable to poor pain assessment and management. Health professionals working with children with profound cognitive impairment from a single paediatric tertiary referral centre in England were interviewed to explore how they develop and acquire knowledge and skills to assess and manage pain in children with cognitive impairment. The interviews were transcribed and subjected to thematic analysis. Nineteen health professionals representing different professional groups and different levels of experience participated in the study. A metatheme "navigating uncertainty; deficits in knowledge and skills" and two core themes "framing as different and teasing things out" and "the settling and unsettling presence of parents" were identified. Uncertainty about aspects of assessing and managing the pain of children with cognitive impairment tended to erode professional confidence and many discussed deficits in their skill and knowledge set. Uncertainty was managed through engaging with other health professionals and the child's parents. Most health professionals stated they would welcome more education and training although many felt that this input should be clinical and not classroom oriented., Competing Interests: The authors declare that they have no competing interests.

Oxygen is one of the commonest health-care interventions worldwide. This might suggest that health-care professionals (HCPs) would be knowledgeable and familiar with its uses and limitations. Yet it is apparent, through clinical audit, that oxygen is probably misunderstood by many HCPs. The aim of this critical interpretive synthesis (CIS) is to explore qualitative and quantitative literature in relation to HCPs beliefs and perceptions of oxygen therapy. A systematic search in Medline, Cinahl, Embase, British Nursing Index and PsychInfo using search terms, such as, oxygen therapy, chronic respiratory disease, HCPs and perceptions yielded 1514 studies of which 12 contained data relevant to the review question. Two reviewers independently screened the articles for eligibility against inclusion and exclusion criteria, and data were selected and synthesized with an integrative and interpretive approach using CIS. This allowed diverse empirical evidence to be synthesized to develop existing and new interpretations of data.Three synthetic constructs were interpreted from the available literature, namely, oxygen for symptom relief, levels of knowledge and understanding and oxygen as a therapy for HCPs. The literature alludes to deep-seated beliefs that exist. In order to enhance practice, these beliefs and cultures need to be challenged. Further research is needed to explore HCPs' perceptions of oxygen therapy in order to inform the seemingly resistant adoption of evidence based practice in relation to oxygen., (© The Author(s) 2014.)

Evidence suggests that nurses can struggle to care for patients with sexually transmitted infections in a non-judgemental way. It is unknown how targeted education can influence the knowledge and attitudes of student nurses towards caring for patients with sexually transmitted infections. This study aimed to investigate how a change in curriculum influenced the reported sexual health knowledge and attitudes of pre-registration adult student nurses in a University in the UK. A two phase mixed methods study, using a sequential explanatory strategy, collected quantitative questionnaire data (n = 117) followed by qualitative group data (n = 12). Data were collected from one cohort of students before a curriculum change and then from a subsequent cohort of students. Those students who had increased educational input in relation to sexual health reported higher degrees of knowledge and demonstrated a more positive attitude towards patients with a sexually transmitted infection. Both cohorts of students identified that education in this subject area was essential to challenge negative attitudes and positively influence patient care. Active learning approaches in the curriculum such as small group debates and service user involvement have the ability to allow students to express and challenge their beliefs in a safe and supportive environment., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Mentoring provides an essential quality assurance mechanism within undergraduate support and assessment of nurses. Recent changes to the standards for supporting pre-registration learners in clinical practice have provided additional structure to this process. Existing evidence suggests there are numerous challenges such as balancing clinical and mentoring priorities and making appropriate decisions; evidence about the sign-off mentor role in particular is currently lacking. This study explores the impact of the sign-off mentor role within the acute setting utilising a phenomenological approach. A purposive sample of 6 sign-off mentors contributed to data collection via the use of semi-structured interviews. Data were collected using a digital tape recorder and transcribed verbatim. Analysis of findings allowed for the development of 3 main themes which are accountability, time and commitment. A key finding of this study is the change in focus for sign-off mentors to one of assessment of clinical competence and professional regulation as opposed to mentors who have concentrated on the teaching and pastoral aspects of this role. However, sustainability requires further investment in this new role from a managerial and educational perspective. Recommendations include further attempts to embed protected time into organisational processes, the consideration of limiting students to sign-off mentors when mentoring a final placement student and negotiating maximum number of exposures to this role within a set time frame., (© 2013.)

Identifying general practice trainees at risk of failing the CSA early in their training is important so that supportive measures can be put in place to ensure training progression. The aim of this study was to determine aspects of the trainee's learning portfolio activity which might predict performance in the CSA. From the Mersey School of General Practice records, details were obtained for trainees who had completed their ST3 year between 1 August and 31 December 2012 with respect to the numbers of entries for the Mini Clinical Evaluation Exercise (Mini-CEX), case-based discussions (CBDs), directly observed procedures (DOPS), learning logs and personal development plans (PDPs) that they had carried out in each of their ST1 and ST2 years. Gender, university of qualification and years since qualification were also recorded. Records were obtained for 116 trainees (94 had passed their CSA). ST1 number of CBD and ST1 number of DOPS, university of qualification, gender, and shorter time since qualification were significantly associated with CSA pass. A multivariate model indicated that graduation from a European university and being female were both associated with an increased chance of passing. Longer time since qualification, non-European university graduation and male gender are the strongest predictors of failing the CSA. Portfolio activity is not a predictor of CSA outcome.

When a newly appointed clinical education team was asked to set up a BSc (Hons) nursing programme, the team agreed that first-year students should receive early exposure to simulation exercises.

A questionnaire study was undertaken with trainers and trainees from 12 deaneries in England and Northern Ireland in June 2010 to evaluate workplace-based assessments (WPBAs) in foundation training. From the sample consisting of 741 trainers and 643 foundation trainees, experience of WPBAs was positive overall, playing an important role in trainees' learning during foundation training and building confidence. However, there is a need for comprehensive training in the WPBA tools used to ensure their efficacy.

Background: This study aimed to explore the factors which influence student nurses' ability to urethrally catheterize children in their care. This aimed to inform current pre-registration clinical skill training and education., Methodology: A mixed method study using focus groups and written questionnaires., Results: The students identified that being able to competently carry out urethral catheterisation was influenced by a lack of exposure to the clinical skill and a need for specific paediatric focused training. Evaluation of current catheterisation training highlighted that, even after training, only a small proportion of the student nurses (24%, n=12) felt confident to catheterize children in practice., Conclusion: Student nurses infrequently witnessed paediatric urethral catheterisation in clinical placements which impacted on their ability to consolidate their learning and build competency in this clinical skill. Limited exposure to some clinical skills in practice, may mean that student nurses' education should focus on skills they are more likely to witness in order to optimise their learning opportunities., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aims and Objectives: This research study explored the factors which influenced the ability of children's nurses to urethrally catheterise children in their care., Background: There is currently limited evidence to inform the clinical skills training of children's nurses and the impact of competencies and other educational documents on practice. The project aimed to use data to inform local service provision and the design and development of future training programmes in an acute paediatric hospital., Design: A mixed method study using questionnaires and focus groups., Methods: Data were obtained through two focus groups (n = 10) and questionnaires (n = 34, response rate 88%) with trained children's nurses to explore the influencing factors on their ability to conduct this clinical skill., Results: The children's nurses discussed that barriers to being competent and confident to catheterise included a lack of exposure to the clinical skill, increasing awareness of the role of competencies and litigation and the presence of specialist roles. Current catheterisation training was evaluated positively with most nurses stating their knowledge and clinical skills had increased; despite this only 55% (n = 18) identified that would feel able to catheterise a child in their care., Conclusions: Comprehensive training of all children's nurses in an acute care setting may not provide a workforce, which is competent and confident in urethrally catheterising children, and resources for training may be more appropriately deployed to ensure the optimum care of children and families., Relevance to Clinical Practice: This study highlights the difficulties encountered for clinical nurses to remain competent in infrequently used clinical skills. This has relevance to the challenges of providing a multi-skilled workforce in children's nursing., (© 2010 Blackwell Publishing Ltd.)

Doctors in specialist training posts in the Mersey Deanery are expected to reflect on their clinical practice and to document their learning experiences in an e-portfolio. This study aims specifically to explore how they have engaged in reflection on their practice and how they utilise their learning portfolio to document evidence of this. A modified Delphi technique was used to develop a grading system to identify the level of reflection recorded by participants in the e-portfolio. Transcripts of the reflective accounts were then analysed using a qualitative approach which involved coding and categorising the data. This study demonstrated a wide variation in both the quantity and quality of reflection. Of particular note in the qualitative data analysis were themes relating to clinical knowledge and skills, learning in practice, communication, feelings, types of learning experience reflected on and wider aspects of medical practice. Findings indicate there is variation is the extent to which doctors both engage in and document evidence of reflection. Further research is needed to explore factors that enable or inhibit the use of the e-portfolio for reflection and whether recorded reflection is a true picture of the cognitive process involved.

Aim: To evaluate users' perceptions of an online numeracy assessment tool in terms of improving their numeracy and confidence in mathematical calculation., Method: A quantitative and qualitative survey evaluation was performed. An online questionnaire was sent to 695 users of the tool. A response rate of 46% was achieved. Questions posed related to three broad areas: the respondents' mathematical qualifications and perceived level of competence, perceptions of the practice exercises and assessment, and the usability and design of the numeracy assessment tool., Findings: After accessing the online numeracy tool, 23% of users undertook additional study to enhance their numeracy; 88% passed the practice assessment first time; 66% reported that the practice calculations reduced their anxiety about the final non-medical prescribing assessment; and 96% found the tool easy to use., Conclusion: Competence in numeracy is an important skill for all healthcare professionals, including prescribers. The numeracy assessment tool enables poor numeracy skills to be identified and support provided to improve the calculation skills of clinical staff.

The ability to perform calculations competently is a basic requirement for all nurses. Calculations are used in everyday tasks such as working out drug doses, body mass index and fluid balance charts. Healthcare staff may have problems with numeracy and this can lead to drug errors, which can have a devastating effect on patients. The author argues that healthcare professionals' numeracy skills should be assessed on a regular basis using a recognised, validated and reliable assessment tool.

This article investigates the perspectives of University of Liverpool graduate foundation doctors and their consultants on their preparedness for professional practice.

Background: Up to 6000 patients per year in England acquire a central venous catheter (CVC)-related bloodstream infection (Shapey et al. 2008 ). Implementation of Department of Health guidelines through educational interventions has resulted in significant and sustained reductions in CVC-related blood stream infections (Pronovost et al. 2002), and cost (Hu et al. 2004 )., Aim: This review aimed to determine the features of structured educational interventions that impact on competence in aseptic insertion technique and maintenance of CV catheters by healthcare workers., Methods: We looked at changes in infection control behaviour of healthcare workers, and considered changes in service delivery and the clinical welfare of patients involved, provided they were related directly to the delivery method of the educational intervention., Results: A total of 9968 articles were reviewed, of which 47 articles met the inclusion criteria., Conclusions: Findings suggest implications for practice: First, educational interventions appear to have the most prolonged and profound effect when used in conjunction with audit, feedback, and availability of new clinical supplies consistent with the content of the education provided. Second, educational interventions will have a greater impact if baseline compliance to best practice is low. Third, repeated sessions, fed into daily practice, using practical participation appear to have a small, additional effect on practice change when compared to education alone. Active involvement from healthcare staff, in conjunction with the provision of formal responsibilities and motivation for change, may change healthcare worker practice.

The purpose of this article is to share our findings since introducing the recently-developed anaesthetic assistant competencies (NHS Education for Scotland 2006). The term 'anaesthetic assistant' will be used throughout this article to refer to those who support the anaesthetist during anaesthesia. It is in no way meant to be derogatory to any person practising currently in this speciality.

With the expansion of nurse prescribing to include the whole British National Formulary, it is essential that all prescribing nurses can accurately calculate and check medication doses. A more uniform approach to professional education for nurse prescribers is needed. This process would be assisted by dissemination of existing good practice and adjustments to the current national standards of assessment.