Publications by authors named "Gabrielle Finn"

87 Publications

Creating a Sport and Exercise Medicine Masters syllabus for doctors: a Delphi study.

BMJ Open Sport Exerc Med 2022 8;8(2):e001252. Epub 2022 Apr 8.

University of Manchester, Manchester, UK.

Objective: Sport and Exercise Medicine (SEM) Masters curricula vary. This Delphi study is aimed to create a consensus curriculum for doctors undertaking SEM Masters courses.

Methods: A modified Delphi survey was used. An expert panel was established of individuals deemed to have adequate knowledge of the field. The research group developed the initial draft of the curriculum by collating and reviewing previously published UK-based postgraduate SEM-related curricula. There were two phases. In phase 1 the expert group either accepted, rejected or modified each learning objective (LO). During phase 2 the expert group were asked to accept or reject each LO that did not get accepted outright previously. The research group analysed the levels of agreements and the comments given by the expert panel after each phase.

Results: The expert panel consisted of 45 individuals, with 35 completing phase 2 (78% retention rate). Of the 136 LOs initially collated: 71 (52%) were accepted outright, 60 (44%) were altered in some way and reincluded in phase 2, and 5 (4%) were removed after phase 1. The research group added 2 (1%) new LOs on reflection over comments made by the expert panel. The final curriculum contained 133 LOs, divided into 11 subthemes.

Conclusions: The findings will better inform educators when developing SEM Masters curricula and inform students what they should look for when considering an SEM Masters. This consensus curriculum is an important step in standardising postgraduate SEM education.
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http://dx.doi.org/10.1136/bmjsem-2021-001252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995950PMC
April 2022

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study.

Acad Med 2022 May 10. Epub 2022 May 10.

G.M. Finn is professor of medical education and vice dean of teaching and learning, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom; ORCID: http://orcid.org/0000-0002-0419-694X.

Purpose: Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an "ethic of caring." Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally.

Method: This was a longitudinal qualitative study from 2019-2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students' identity construction during LICs. Data collection involved 3 stages: individual, semi-structured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio-diaries throughout. Data were analyzed inductively using a reflexive thematic approach.

Results: Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students' social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors.

Conclusions: Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.
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http://dx.doi.org/10.1097/ACM.0000000000004732DOI Listing
May 2022

Can stoic training develop medical student empathy and resilience? A mixed-methods study.

BMC Med Educ 2022 May 3;22(1):340. Epub 2022 May 3.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Background: Empathic erosion and burnout represent crises within medicine. Psychological training has been used to promote empathy and personal resilience, yet some training useful within adjacent fields remain unexplored, e.g., Stoic training. Given recent research within psychology suggesting that Stoic training increases emotional wellbeing, exploring this type of training within health professions education is important. We therefore asked: What impact would a Stoicism informed online training package have on third year medical students' resilience and empathy?

Methods: 24 third year medical students took part in 12 days of online training (SeRenE), based on Stoic philosophy, and co-developed with psychotherapists. A mixed-methods study was conducted to evaluate impact. Pre- and post-SeRenE students completed the Stoic Attitudes and Behaviours Scale (SABS), Brief Resilience Scale (BRS) and Jefferson Scale of Empathy (JSE). All students completed semi-structured interviews following training and 2 months post-SeRenE. Thematic analysis was employed to analyse qualitative data, whilst within subjects t-tests and correlational analyses were conducted on quantitative data.

Results: Quantitatively, stoic ideation, resilience and empathy increased post-training, with correlational analyses suggesting resilience and empathy increase in tandem. Qualitatively, four themes were identified: 1. Negative visualisation aids emotional and practical preparedness; 2. Stoic mindfulness encourages students to think about how they think and feel; 3. Stoic reflection develops the empathic imagination; and 4. Evaluating the accessibility of SeRenE.

Conclusions: Our data lend support to the ability of Stoic-based psychological training to positively influence resilience and empathy. Although, quantitatively, results were mixed, qualitative data offers rich insight. The practice of negative visualisation, promoted by SeRenE, encourages student self-efficacy and planning, domains of resilience associated with academic success. Further, this study demonstrates a connection between Stoic practice and empathy, which manifests through development of the empathic imagination and a sense of empathic bravery.
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http://dx.doi.org/10.1186/s12909-022-03391-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9064267PMC
May 2022

Tips to Support the Recruitment, Retention, and Progression of Clinical Academics.

Med Sci Educ 2022 Apr 16;32(2):503-509. Epub 2022 Feb 16.

University of Manchester, England, UK.

Training to become a clinical academic is a long and arduous process with many obstacles. Many potential candidates fall by the wayside both during and following completion of the combined clinical and academic training pathway with negative implications for clinical and translational research and teaching. Findings from a recent national multi-funder study, alongside clinical academic experiences and current literature, have led to the creation of this 12-tip paper. The tips are targeted at supervisors and employers of clinical academics, aiming to improve recruitment, experiences, retention, and progression through the career path.
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http://dx.doi.org/10.1007/s40670-022-01512-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8853407PMC
April 2022

Colonization, cadavers, and color: Considering decolonization of anatomy curricula.

Anat Rec (Hoboken) 2022 04 5;305(4):938-951. Epub 2022 Jan 5.

School of Dental Sciences, Newcastle University, Newcastle, UK.

Anatomy is a discipline that, despite its universal nature, offers limited diversity in terms of representation in cadavers, imagery, technology, and models used within teaching. The universal move toward inclusive curricula has put anatomy education under the microscope, particularly with respect to efforts to decolonize curricula. This paper considers the challenges and opportunities to diversify the anatomy curriculum. Decolonizing anatomy education curricula will entail addressing the ingrained cultures within the disciplines, such that produces a number of challenges including: underrepresentation of certain bodies, difficulty talking about difference, and the hidden curriculum in anatomy education. In order to aid educators in achieving inclusive anatomy curricula, a toolkit and considerations are presented, alongside both do's, don'ts and case examples. We highlight the black-or-white dichotomy, and the absence of brown in between. The paper is a conversation starter for what it means to begin the process of decolonizing the curriculum within anatomy education.
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http://dx.doi.org/10.1002/ar.24855DOI Listing
April 2022

Responsibility with a Safety Net: Exploring the Medical Student to Junior Doctor Transition During COVID-19.

Med Sci Educ 2022 Feb 1;32(1):121-129. Epub 2021 Dec 1.

Health Professions Education Unit, Hull York Medical School, York, UK.

Introduction: The Foundation Interim Year-one (FiY1) Programme was part of a UK strategy to increase the medical workforce in response to the COVID-19 pandemic. However, the strategy was introduced urgently without evidence. We sought to explore the transition experience of medical student to FiY1 to foundation doctor, with a view to inform future undergraduate education.

Methods: In this hermeneutic phenomenology study, semi-structured individual interviews were completed with nine foundation doctors who had experience of an FiY1 placement. A template analysis approach was taken, and themes reported.

Results: Participants reported that FiY1 tended to offer a positive experience of transition as a stepping stone to becoming a foundation doctor. Having a degree of clinical responsibility including the right to prescribe medication with supervision was highly valued, as was feeling a core member of the healthcare team. Participants perceived that FiY1 made them more prepared for the foundation transition, and more resilient to the challenges they faced during their first foundation job.

Discussion: The FiY1 fostered many opportunities for junior doctors to bridge the transition to foundation doctor. Aspects of the FiY1 programme, such as early licencing and increased team membership, should be considered for final-year students in the future.
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http://dx.doi.org/10.1007/s40670-021-01476-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635475PMC
February 2022

A virtual community is an empowered community: Taking medical education online, paws and all.

Authors:
Gabrielle M Finn

Clin Teach 2021 12;18 Suppl 1:4-5

Interim Director of Events, ASME, University of Manchester, Manchester, UK.

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http://dx.doi.org/10.1111/tct.13419DOI Listing
December 2021

A proactive approach to tackling sexism in medical school.

BMJ 2021 11 10;375:n2730. Epub 2021 Nov 10.

Faculty of Biology, Medicine, and Health, University of Manchester, M13 9PL.

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http://dx.doi.org/10.1136/bmj.n2730DOI Listing
November 2021

Empathy in Medical Education: Its Nature and Nurture - a Qualitative Study of the Views of Students and Tutors.

Med Sci Educ 2021 Oct 15:1-10. Epub 2021 Oct 15.

Health Professions Education Unit, Hull York Medical School, York, UK.

Context: Medical education is committed to teaching patient centred communication and empathy. However, quantitative research suggests empathy scores tend to decline as students progress through medical school. In qualitative terms, there is a need to better understand how students and tutors view the practice and teaching of clinical empathy and the phenomenon of empathic erosion.

Methods: Working within a constructivist paradigm, researchers thematically analysed the individual interview data from a purposive sample of 13 senior students and 9 tutors.

Results: The four major themes were as follows: (1) 'the nature of empathy', including the concept of the innate empathy that students already possess at the beginning of medical school; (2) 'beyond the formal curriculum' and the central importance of role modelling; (3) 'the formal curriculum and the tick-box influence of assessments'; and (4) the 'durability of empathy', including ethical erosion and resilience. A garden model of empathy development is proposed - beginning with the innate seeds of empathy that students bring to medical school, the flowering of empathy is a fragile process, subject to both enablers and barriers in the formal, informal, and hidden curricula.

Conclusion: This study provides insights into empathic erosion in medical school, including the problems of negative role modelling and the limitations of an assessment system that rewards 'tick-box' representations of empathy, rather than true acts of compassion. It also identifies factors that should enable the flowering of empathy, such as new pedagogical approaches to resilience and a role for the arts and humanities.
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http://dx.doi.org/10.1007/s40670-021-01430-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519626PMC
October 2021

Pandemics, Protests, and Pronouns: The Changing Landscape of Biomedical Visualisation and Education.

Adv Exp Med Biol 2021 ;1334:39-53

Hull York Medical School, University of York, Heslington, York, UK.

Events in early 2020 changed the landscape of education for the foreseeable future, perhaps permanently. Three events had a significant impact; (1) the Coronavirus disease 2019 (COVID-19) pandemic, (2) the death of George Floyd, which resulted in the most recent Black Lives Matter (BLM) protests, and (3) the Twitter storm, the resultant societal fallout and freedom of speech campaigns, following comments made by author JK Rowling which many deemed transphobic. These events had a differential impact on biomedical sciences, when compared to other sectors. COVID-19 resulted in a global lockdown, with higher education institutions closing campuses and moving to online-only delivery. This rapid change required radical shifts in the use of technology, with mass delivery of teaching at short notice. The BLM protests further raised awareness of the inequalities within society, particularly those experienced by Black people and other oppressed groups. As a result, there have been calls for the decolonisation of the curriculum. The implications of these three key events have led institutions to rethink their policies, teaching delivery, assessment, curricula, and physical environments. This chapter considers (1) the implications of a swift change in the primary mode of curriculum delivery within Higher Education to online formats and (2) how recent adverse events have resulted in calls for much-needed changes in visual representations within biomedical sciences. Finally, we consider (3) the role of the hidden curriculum and the potential impact of visual representations in curricula on the delivery of healthcare and the fight against health inequalities, which are often as a result of implicit biases. The year 2020 has proven timely in presenting the opportunity for change, provided through the power of imagery.
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http://dx.doi.org/10.1007/978-3-030-76951-2_3DOI Listing
September 2021

Thoughts that breathe, and words that burn: poetic inquiry within health professions education.

Perspect Med Educ 2021 10 1;10(5):257-264. Epub 2021 Sep 1.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Qualitative inquiry is increasingly popular in health professions education, and there has been a move to solidify processes of analysis to demystify the practice and increase rigour. Whilst important, being bound too heavily by methodological processes potentially represses the imaginative creativity of qualitative expression and interpretation-traditional cornerstones of the approach. Rigid adherence to analytic steps risks leaving no time or space for moments of 'wonder' or emotional responses which facilitate rich engagement. Poetic inquiry, defined as research which uses poetry 'as, in, [or] for inquiry', offers ways to encourage creativity and deep engagement with qualitative data within health professions education. Poetic inquiry attends carefully to participant language, can deepen researcher reflexivity, may increase the emotive impact of research, and promotes an efficiency of qualitative expression through the use of 'razor sharp' language. This A Qualitative Space paper introduces the approach by outlining how it may be applied to inquiry within health professions education. Approaches to engaging with poetic inquiry are discussed and illustrated using examples from the field's scholarship. Finally, recommendations for interested researchers on how to engage with poetic inquiry are made, including suggestions as to how to poetize existing qualitative research practices.
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http://dx.doi.org/10.1007/s40037-021-00682-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505582PMC
October 2021

A Rapid Review of Prescribing Education Interventions.

Med Sci Educ 2021 Feb 16;31(1):273-289. Epub 2020 Nov 16.

Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK.

Introduction: Many studies conducted on the causes and nature of prescribing errors have highlighted the inadequacy of teaching and training of prescribers. Subsequently, a rapid review was undertaken to update on the nature and effectiveness of educational interventions aimed at improving the prescribing skills and competencies.

Methods: Twenty-two studies taking place between 2009 and 2019 were identified across nine databases.

Results And Discussion: This review reinforced the importance of the WHO Guide to Good Prescribing to prescribing curriculum design as well as the effectiveness of small group teaching. However, it also highlighted the lack of innovation in prescribing education and lack of longitudinal follow-up regarding the effectiveness of prescribing education interventions.
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http://dx.doi.org/10.1007/s40670-020-01131-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368780PMC
February 2021

Exploring the Hidden Curriculum's Impact on Medical Students: Professionalism, Identity Formation and the Need for Transparency.

Med Sci Educ 2020 Sep 24;30(3):1107-1121. Epub 2020 Jul 24.

Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK.

The hidden curriculum within medical education has been a topic of recent debate. Consensus opinion regarding the continued relevance of this term, what constitutes the hidden curriculum, and the nature of its impact do not exist. Further research is required to contribute to this debate. This work sets out to investigate which factors beyond taught cognitive knowledge influence medical students in clinical and educational environments and examine how this occurs. Semi-structured focus group interviews were conducted with 39 students from one UK medical school. Fourteen faculty were interviewed individually to triangulate data. Data were analysed using constructivist thematic analysis, informed by grounded theory convention. The presence of the hidden curriculum was clearly demonstrated, acting through role modelling, organizational culture, stereotyping and professional dress. Mentioned frequently were the influences of the hidden curriculum on student professionalism and identity development. Professionalism was perceived as being negatively impacted by the hidden curriculum and seen as an imposition from senior faculty to control students. Students believe medical identity formation begins prior to medical school, in a process known as "anticipatory socialization", a previously unstudied identity transition. Students felt covert institutional agendas negatively impacted their identity, pushing them further from the identity their institution was encouraging them to acquire. Key messages for educators include the need to explore the hidden curriculum through discussion with students. Improving transparency of organizational culture may allow students to interpret institutional agendas in the way institutions formally intend, reducing orthogonal interpretations of organizational culture and subsequent impact upon identity formation.
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http://dx.doi.org/10.1007/s40670-020-01021-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368648PMC
September 2020

Will removing intercalation undermine our clinical academic foundations?

BMJ 2021 08 3;374:n1527. Epub 2021 Aug 3.

Health Professions Education Unit, Hull York Medical School, University of York, York YO10 5DD, UK.

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http://dx.doi.org/10.1136/bmj.n1527DOI Listing
August 2021

Anatomy education for medical students in the United Kingdom and Republic of Ireland in 2019: A 20-year follow-up.

Anat Sci Educ 2021 Jul 27. Epub 2021 Jul 27.

Human Anatomy Unit, Department of Surgery and Cancer, Imperial College London, London, UK.

Anatomical education in the United Kingdom (UK) and Ireland has long been under scrutiny, especially since the reforms triggered in 1993 by the General Medical Council's "Tomorrow's Doctors." The aim of the current study was to investigate the state of medical student anatomy education in the UK and Ireland in 2019. In all, 39 medical schools completed the survey (100% response rate) and trained 10,093 medical students per year cohort. The teachers comprised 760 individuals, of these 143 were employed on full-time teaching contracts and 103 were employed on education and research contracts. Since a previous survey in 1999, the number of part-time staff has increased by 300%, including a significant increase in the number of anatomy demonstrators. In 2019, anatomy was predominantly taught to medical students in either a system-based or hybrid curriculum. In all, 34 medical schools (87%) used human cadavers to teach anatomy, with a total of 1363 donors being used per annum. Gross anatomy teaching was integrated with medical imaging in 95% of medical schools, embryology in 81%, living anatomy in 78%, neuroanatomy in 73%, and histology in 68.3%. Throughout their five years of study, medical students are allocated on average 85 h of taught time for gross anatomy, 24 h for neuroanatomy, 24 h for histology, 11 h for living anatomy, and 10 for embryology. In the past 20 years, there has been an average loss of 39 h dedicated to gross anatomy teaching and a reduction in time dedicated to all other anatomy sub-disciplines.
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http://dx.doi.org/10.1002/ase.2126DOI Listing
July 2021

Understanding gateway to medicine programmes.

Clin Teach 2021 10 17;18(5):558-564. Epub 2021 May 17.

Health Professions Education Unit, Hull York Medical School, York, UK.

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.
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http://dx.doi.org/10.1111/tct.13368DOI Listing
October 2021

Are efforts to recruit to psychiatry closing the stable door after the horse has bolted? Knowledge and attitudes towards a career in psychiatry amongst secondary (high) school students: a UK-based cross-sectional survey.

J Ment Health 2021 May 17:1-8. Epub 2021 May 17.

Hull York Medical School, University of York, York, UK.

Background: Internationally there is a shortage of psychiatrists, whilst clinical psychology training is generally oversubscribed. School students interested in psychological health may not be aware of the possibility of studying medicine before specialising in psychiatry. This has implications for the mental health workforce.

Aims: To evaluate the knowledge and attitudes relating to a potential career in psychiatry amongst secondary (high) school students.

Method: A cross-sectional survey evaluated attitudes and knowledge relating to psychiatry and clinical psychology, targeting students from five schools who were studying chemistry, biology and/or psychology at an advanced level.

Results: 186 students completed the survey (response rate 41%). Knowledge was generally poor with only 57% of respondents knowing that psychiatrists had medical degrees, and most participants substantially underestimating the salaries of consultant psychiatrists. Attitudinal response patterns were explained by two underlying factors, relating to generally negative attitudes towards psychiatry and positive attitudes towards the effectiveness of psychiatric treatments. Females and those studying psychology reported more positive attitudes towards psychiatry. Those studying chemistry reported more negative attitudes towards the effectiveness of mental health treatment.

Conclusions: Studying psychology predicted positive attitudes towards psychiatry. Such students could be targeted by recruitment campaigns, which emphasise factual information about the specialty.
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http://dx.doi.org/10.1080/09638237.2021.1922638DOI Listing
May 2021

A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry.

Adv Health Sci Educ Theory Pract 2021 Oct 13;26(4):1229-1253. Epub 2021 Apr 13.

Health Professions Education Unit, Hull York Medical School, York, UK.

Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.
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http://dx.doi.org/10.1007/s10459-021-10046-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452574PMC
October 2021

Do We Need to Close the Door on Threshold Concepts?

Teach Learn Med 2021 Mar 26:1-12. Epub 2021 Mar 26.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Issue: Threshold Concepts are increasingly used and researched within health professions education. First proposed by Meyer and Land in 2003, they can be defined as ways of knowing central to the mastery of a subject. They are framed as profoundly transformative, impacting the identity of those who encounter them through irreversible shifts in an individual's outlook. Although Threshold Concepts have been identified in a multitude of educational settings across the continuum of health professions education, there has been little critique of Threshold Concepts as a theory of health professions education. Within adjacent fields critical discourse is also underdeveloped, perhaps given the educational resonance of the theory, or the way in which the theory encourages subject specialists to discuss their area of interest in depth. This commentary critically examines how Threshold Concepts have been used and researched within health professions education, applying critiques from other educational fields, to assist scholars in thinking critically regarding their application.

Evidence: Three significant critiques are outlined: 1) '; 2) '; and 3) ' Critique 1, the floating signifier problem, outlines how Threshold Concept theory lacks articulation and has been inconsistently operationalized. Critique 2, the body of knowledge problem, outlines the issues associated with attempting to identify a singular body of knowledge, particularly in regard to the reinforcement of entrenched power dynamics. Critique 3, the professional identity problem, argues that the way in which Threshold Concepts conceptualize identity formation is problematic, inadequately grounded in wider academic debate, and at odds with increasingly constructionist conceptualizations of identity within health professions education.

Implications: These critiques have implications for both educators and researchers. Educators using Threshold Concepts theory must think carefully about the tacit messages their use communicates, consider how the use of Threshold Concepts could reinforce entrenched power dynamics, and reflect on how their use may make material less accessible to some learners. Further, given that Threshold Concept theory lacks articulation, using the theory to structure curricula or educational sessions is problematic. Threshold Concepts are not synonymous with course learning outcomes and so, While considering Threshold Concepts may enable pedagogical discussion, the theory cannot help educators decide which concepts it applies to; this requires careful planning which extends beyond the bounds of this theory. For researchers, there are issues too with power and inconsistent theoretical operationalization, but also with the way in which Threshold Concepts theory conceptualizes identity formation, which cast doubt on its use as a theory of identity development. On balance, we believe Threshold Concept theory suffers a number of fundamental flaws that necessitate a shift from the positioning of Threshold Concepts as a theory, toward the use of Threshold Concepts as a less prescriptive reflective prompt to stimulate pedagogical discussion.
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http://dx.doi.org/10.1080/10401334.2021.1897598DOI Listing
March 2021

When I say… socialisation.

Med Educ 2021 07 18;55(7):780-781. Epub 2021 Feb 18.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

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http://dx.doi.org/10.1111/medu.14469DOI Listing
July 2021

Can the arts and humanities bring the patient's voice centre stage in medical education?

Med Educ 2021 05 22;55(5):546-548. Epub 2021 Feb 22.

Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.

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http://dx.doi.org/10.1111/medu.14466DOI Listing
May 2021

Love and breakup letter methodology: A new research technique for medical education.

Med Educ 2021 07 22;55(7):818-824. Epub 2021 Feb 22.

Health Professions Education Unit, Hull York Medical School, York, UK.

In everyday life, feelings are important to us, influencing our decision-making and motivating our actions. This is equally true within medicine and medical education, where feelings influence key aspects such as clinical decision-making, empathy, resilience, professional identity, reflection, team dynamics, career choices and questions of prejudice and bias. Feelings are therefore legitimate targets in medical education research, but asking research participants to talk openly about feelings can be challenging for participants and researchers alike. Within the disciple of User Experience (UX)-a relatively new research discipline used in the world of technology-researchers also seek to understand their customer's feelings, which are central to aspects of brand loyalty and choice of software platforms. UX researchers have developed innovative ways to explore feelings, in particular through the use of Love and Breakup Methodology (LBM)-participants are asked to write love and breakup letters to the product or app under study, and the letters are then used to guide the focus group discussion that follows. Methods: In this article, we describe the theoretical underpinnings of LBM, including ontological considerations. We also consider how LBM can be successfully used in medical education research and outline how we have adapted it in our own research studies and programme evaluations. Conclusions: Love and breakup letters are creative ways of understanding participants' positive and negative emotions about the matter under study. LBM has been utilised extensively by UX researchers in technology, but has been little used in medical education. It has rich potential to enhance research approaches to aspects of medicine that are influenced by feelings, including empathy and resilience, team working and many other aspects of professional practice. Although principally a focus group research tool, it can be adapted to other approaches, including questionnaire surveys and individual interviews.
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http://dx.doi.org/10.1111/medu.14463DOI Listing
July 2021

Professional identity formation within longitudinal integrated clerkships: A scoping review.

Med Educ 2021 08 24;55(8):912-924. Epub 2021 Feb 24.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Context: Although the uptake of Longitudinal Integrated Clerkships (LICs) is increasing worldwide, and there are documented benefits to participation, there is a lack of conceptual evidence regarding how LICs exert many of their benefits, including their influence on the recruitment and retention of practitioners to underserved areas or specialties. Whilst career choice and professional identity development have been previously connected within medicine, what is known about the ways in which LICs influence identity remains unclear. A scoping review was conducted to explore current knowledge and map directions for future research.

Method: In 2020, the authors searched nine bibliographic databases for articles discussing identity within the context of LICs using a systematic search strategy. Two reviewers independently screened all articles against eligibility criteria and charted the data. Eligible articles were analysed by quantitative and qualitative thematic analysis.

Results: 849 articles were identified following an extensive search. 131 articles were selected for full-text review, with 27 eligible for inclusion. Over half of all articles originated from the United States or Canada, and research most frequently explored identity development from sociocultural orientations. Qualitatively, four themes were identified: (a) The importance of contextual continuities; (b) Symbiotic relationship of responsibility and identity development; (c) Becoming a competent carer; and (d) Influence of LICs on career identity.

Conclusions: This scoping review adds weight to the supposition that participation in LICs facilitates identity development, namely through contextual continuities and the responsibility students assume as they become co-providers of patient care. There are suggestions that LICs encourage the development of an 'ethic of caring'. As little research compares comprehensive LICs with other clerkship models, it remains difficult to say to what degree identity formation is facilitated above and beyond other models. Future comparative research, and research exploring identity formation from diverse theoretical perspectives would add depth.
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http://dx.doi.org/10.1111/medu.14461DOI Listing
August 2021

When I say… empathic dissonance.

Med Educ 2021 04 18;55(4):428-429. Epub 2021 Jan 18.

Division of Medical Education, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, UK.

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http://dx.doi.org/10.1111/medu.14441DOI Listing
April 2021

Integrating sport and exercise medicine clinics into the National Health Service: a qualitative study.

BMJ Open Sport Exerc Med 2020 3;6(1):e000888. Epub 2020 Nov 3.

Centre for Sports Medicine, Queens Medical Centre Nottingham, Nottingham, UK.

Objectives: To explore the services National Health Service (NHS)-based sport and exercise medicine (SEM) clinics can offer, and the barriers to creating and integrating SEM services into the NHS.

Methods: Semi-structured interviews were undertaken to collect data from identified 'stakeholders'. Stakeholders were identified as individuals who had experience and knowledge of the speciality of SEM and the NHS. An inductive thematic analysis approach was taken to analyse the data.

Results: N=15 stakeholder interviews. The management of musculoskeletal (MSK) injuries (both acute and chronic) and concussion were highlighted as the two key services that SEM clinics can offer that would most benefit the NHS. MSK ultrasound was also mentioned by all stakeholders as a critical service that SEM clinics should provide. While exercise medicine is an integral part of SEM, SEM clinics should perhaps not have a heavy exercise medicine focus. The key barriers to setting up SEM clinics were stated to be convincing NHS management, conflict with other specialities and a lack of awareness of the speciality.

Conclusion: The management of acute MSK injuries and concussion should be the cornerstone of SEM services, ideally with the ability to provide MSK ultrasound. Education of others on the speciality of SEM, confirming consistent 'unique selling points' of SEM clinics and promoting how SEM can add value to the NHS is vital. If the successful integration of SEM into the NHS is not widely achieved, we risk the NHS not receiving all the benefits that SEM can provide to the healthcare system.
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http://dx.doi.org/10.1136/bmjsem-2020-000888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672496PMC
November 2020

Body Painting Plus: Art-Based Activities to Improve Visualisation in Clinical Education Settings.

Adv Exp Med Biol 2020 ;1260:27-42

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Art-based activities are increasingly being regarded as an accessible and engaging way to understand the human body and its processes. Such activities include body painting (both regular and ultraviolet [UV]), clay and materials-based modelling and drawing-focused activities. Integrating art-based approaches into curricula can offer many benefits and are often cost-effective ways to engage students, and improve on clinical acumen and visual understanding of the body. In this chapter, we will introduce various art-based visualisation methods, suggested uses for their integration into curricula, as well as the associated pros and cons of each, in turn.
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http://dx.doi.org/10.1007/978-3-030-47483-6_3DOI Listing
January 2021

Navigating the qualitative manuscript writing process: some tips for authors and reviewers.

BMC Med Educ 2020 11 16;20(1):439. Epub 2020 Nov 16.

Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9NT, Manchester, UK.

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http://dx.doi.org/10.1186/s12909-020-02370-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7668005PMC
November 2020

What makes a model prescriber? A documentary analysis.

Med Teach 2021 02 8;43(2):198-207. Epub 2020 Nov 8.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Introduction: In recent years, the authority to prescribe medications in healthcare has expanded to include pharmacists, nurses and Allied Healthcare Professionals. Subsequently, the quantity of guidelines describing appropriate prescribing practice has increased. Despite this, the literature notes a lack of consensus regarding the overall qualities of a good prescriber. The aim of this study was to attempt to define what makes a model prescriber in practice, regardless of professional background.

Methods: A documentary analysis of UK-based and international prescribing practice guidelines was performed. Data analysis was conducted through a constructivist grounded theory approach to enable concepts to be identified from the data itself without the use of pre-defined categories.

Results: A total of 13 guideline documents were analysed. Overall, four core categories of a model prescriber in practice were identified: Knowledgeable: including that of disease and drug properties; Safe: relating to appropriate drug quantities and treatment-monitoring; Good Communicators: with both patients and colleagues; Contemporary: through enhancing knowledge and skills.

Conclusions: These four categories can serve as a definition of a high-level prescriber and as an additional tool for prescribing educators to evaluate the extent their curriculum develops and assesses the core qualities needed by their students to be high-level prescribers in practice.
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http://dx.doi.org/10.1080/0142159X.2020.1839031DOI Listing
February 2021

How medical school alters empathy: Student love and break up letters to empathy for patients.

Med Educ 2021 03 17;55(3):394-403. Epub 2020 Nov 17.

Health Professions Education Unit, Hull York Medical School, York, UK.

Introduction: Medical education is committed to promoting empathic communication. Despite this, much research indicates that empathy actually decreases as students progress through medical school. In qualitative terms, relatively little is known about this changing student relationship with the concept of empathy for patients and how teaching affects it. This study explores that knowledge gap.

Methods: Adopting a constructivist paradigm, we utilised a research approach new to medical education: Love and Breakup Letter Methodology. A purposive sample of 20 medical students were asked to write love and break up letters to 'empathy for patients'. The letters were prompts for the focus group discussions that followed. Forty letters and three focus group discussions were thematically analysed.

Results: The three major themes were: art and artifice; empathic burden; and empathy as a virtue. Students were uncomfortable with the common practice of faking empathic statements, a problem exacerbated by the need to 'tick the empathy box' during examinations. Students evolved their own empathic style, progressing from rote empathic statements towards phrases which suited their individual communication practice. They also learned non-verbal empathy from positive clinician role-modelling. Students reported considerable empathic burden. Significant barriers to empathy were reported within the hidden curriculum, including negative role-modelling that socialises students into having less compassion for difficult patients. Students strongly associated empathy with virtue.

Conclusions: Medical education should address the problem of inauthentic empathy, including faking empathic s in assessments. Educators should remember the value of non-verbal compassionate communication. The problems of empathic burden, negative role modelling and of finding empathy difficult for challenging patients may account for some of the empathy decline reported in quantitative research. Framing empathy as a virtue may help students utilise empathy more readily when faced with patients they perceive as challenging and may promote a more authentic empathic practice.
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http://dx.doi.org/10.1111/medu.14403DOI Listing
March 2021

Holding a mirror up to nature: the role of medical humanities in postgraduate primary care training.

Educ Prim Care 2021 03 14;32(2):73-77. Epub 2020 Sep 14.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

The humanities are academic disciplines that study aspects of human society, experience and culture. Typically, the humanities, including philosophy, literature, art, music, history and language have been used to interpret and record our understanding of the world. In recent decades, the humanities have seen somewhat of a renaissance within medicine, particularly within undergraduate medical education. This leading article explores the value of utilising medical humanities, such as art, poetry and theatre, within postgraduate primary care training. Using examples of approaches already interwoven into the fabric of undergraduate medical education, such as simulated patient consultations and anatomical body painting, the tangible benefits of applying humanities disciplines within general practice training are discussed. The humanities have much to offer from the value of utilising an artistic lens to examine the body, the creation of socially cohesive working environments and supporting the development of empathy within trainees. This article recommends the provision of both increased informal and formal engagement with the medical humanities within postgraduate primary care training, providing practical tips for GP educators looking to integrate the humanities within pre-existing tutorials.
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http://dx.doi.org/10.1080/14739879.2020.1816860DOI Listing
March 2021
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