Publications by authors named "Paul Crampton"

27 Publications

  • Page 1 of 1

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

Med Sci Educ 2021 Dec 1:1-9. 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
December 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

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

Early career doctors' experiences of psychiatry placements: A qualitative study.

Med Teach 2021 Oct 17;43(10):1196-1202. Epub 2021 Jun 17.

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

Introduction: On completion of a medical degree, junior doctors in the UK undergo a 2 year Foundation Programme. Since 2016, 45% of Foundation Programme doctors are required to undertake a psychiatry placement during foundation training. During this time, recruitment to Core Psychiatry Training has fluctuated, dropping to a 69% fill rate in 2017.

Methods: With the support of the Royal College of Psychiatrists, Health Education England and the UK Foundation Programme Office, a large-scale study was formulated utilising semi-structured focus groups. These exploring participant experiences help to understand how and if the psychiatry foundation placements are valuable, and their potential influence on a trainee choosing psychiatry as a career. A framework analysis was used to analyse data.

Results: Seventy-four participants across 10 foundation schools in England participated. Experiences and perceptions were split into three broad themes; pre-placement, during placement, and post-placement. Within these, 12 sub-themes emerged. Doctors valued independence and responsibility especially if accompanied by a level of support from seniors. They also enjoyed working as part of a multi-disciplinary team. However, there were clear issues around staffing levels, stigma attached to psychiatry, and out of hours working.

Discussion: The pre-placement perceptions of psychiatry as a specialty as well as the trainees' personal priorities for career selection were influenced by psychiatry placement experiences. The results have important implications for the recruitment to the specialty and need to be considered when designing and constructing placement aims.
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http://dx.doi.org/10.1080/0142159X.2021.1934425DOI Listing
October 2021

Professional identity formation, intersectionality and equity in medical education.

Med Educ 2021 02 30;55(2):140-142. Epub 2020 Nov 30.

Durham University, Durham, UK.

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http://dx.doi.org/10.1111/medu.14415DOI Listing
February 2021

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

Not all who wander are lost: evaluation of the Hull York medical school longitudinal integrated clerkship.

Educ Prim Care 2021 05 8;32(3):140-148. Epub 2020 Sep 8.

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

Longitudinal integrated clerkships (LICs) are increasingly available within the United Kingdom, but gaps in knowledge remain regarding their efficacy and the influence of local context. In 2019-20, the Hull York Medical School ran a pilot LIC for 6 fourth-year medical students. This work describes the longitudinal qualitative programme evaluation. LIC students participated in two focus groups, one after four months, and another at the end of the programme. In total, 16 faculty were also interviewed regarding their experiences in developing, implementing and running the LIC. Students' GP supervisors were difficult to engage in detailed evaluation due to the COVID-19 pandemic, and so were briefly surveyed at the end of the LIC. All data were pooled and analysed together using reflexive thematic analysis. Two major themes were identified: 'Trajectory of the LIC', describing the learning curve students and faculty encounter, and 'Institutional decision making', describing the need for clarity regarding the programme's purpose. The programme was largely positively received, but areas for improvement locally, and transferrable recommendations, were identified. Aligning assessment to programme aims is an important area for future development, alongside balancing structured with unstructured time, and supporting students as they navigate a J-shaped learning curve.
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http://dx.doi.org/10.1080/14739879.2020.1816859DOI Listing
May 2021

Situational judgement test validity for selection: A systematic review and meta-analysis.

Med Educ 2020 10 25;54(10):888-902. Epub 2020 Aug 25.

Hull York Medical School, York, UK.

Context: Situational judgement tests (SJTs) are widely used to evaluate 'non-academic' abilities in medical applicants. However, there is a lack of understanding of how their predictive validity may vary across contexts. We conducted a systematic review and meta-analysis to synthesise existing evidence relating to the validity of such tools for predicting outcomes relevant to interpersonal workplace performance.

Methods: Searches were conducted in relevant databases to June 2019. Study quality and risk of bias were assessed using the Quality In Prognosis Studies (QUIPS) tool. Results were pooled using random effects meta-analysis and meta-regressions.

Results: Initially, 470 articles were identified, 218 title or abstracts were reviewed, and 44 full text articles were assessed with 30 studies meeting the final inclusion criteria and were judged, overall, to be at moderate risk of bias. Of these, 26 reported correlation coefficients relating to validity, with a pooled estimate of 0.32 (95% confidence interval 0.26 to 0.39, P < .0001). Considerable heterogeneity was observed (I  = 96.5%) with the largest validity coefficients tending to be observed for postgraduate, rather than undergraduate, selection studies (β = 0.23, 0.11 to 0.36, P < .001). The correction of validity coefficients for attenuation was also independently associated with larger effects (β = 0.13, 0.03 to 0.23, P = .01). No significant associations with test medium (video vs text format), cross-sectional study design, or period of assessment (one-off vs longer-term) were observed. Where reported, the scores generally demonstrated incremental predictive validity, over and above tests of knowledge and cognitive ability.

Conclusions: The use of SJTs in medical selection is supported by the evidence. The observed trend relating to training stage requires investigation. Further research should focus on developing robust criterion-relevant outcome measures that, ideally, capture interpersonal aspects of typical workplace performance. This will facilitate additional work identifying the optimal place of SJTs within particular selection contexts and further enhancing their effectiveness.
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http://dx.doi.org/10.1111/medu.14201DOI Listing
October 2020

Teaching medical professionalism: a qualitative exploration of persuasive communication as an educational strategy.

BMC Med Educ 2020 Mar 17;20(1):74. Epub 2020 Mar 17.

Research Department of Medical Education, UCL Medical School (UCLMS), The Directorate, 74 Huntley Street, London, WC1E 6AU, UK.

Background: Across the world, local standards provide doctors with a backbone of professional attitudes that must be embodied across their practice. However, educational approaches to develop attitudes are undermined by the lack of a theoretical framework. Our research explored the ways in which the General Medical Council's (GMC) programme of preventative educational workshops (the Duties of a Doctor programme) attempted to influence doctors' professional attitudes and examined how persuasive communication theory can advance understandings of professionalism education.

Methods: This qualitative study comprised 15 ethnographic observations of the GMC's programme of preventative educational workshops at seven locations across England, as well as qualitative interviews with 55 postgraduate doctors ranging in experience from junior trainees to senior consultants. The sample was purposefully chosen to include various geographic locations, different programme facilitators and doctors, who varied by seniority. Data collection occurred between March to December 2017. Thematic analysis was undertaken inductively, with meaning flowing from the data, and deductively, guided by persuasive communication theory.

Results: The source (educator); the message (content); and the audience (participants) were revealed as key influences on the persuasiveness of the intervention. Educators established a high degree of credibility amongst doctors and worked to build rapport. Their message was persuasive, in that it drew on rational and emotional communicative techniques and made use of both statistical and narrative evidence. Importantly, the workshops were interactive, which allowed doctors to engage with the message and thus increased its persuasiveness.

Conclusions: This study extends the literature by providing a theoretically-informed understanding of an educational intervention aimed at promoting professionalism, examining it through the lens of persuasive communication. Within the context of interactive programmes that allow doctors to discuss real life examples of professional dilemmas, educators can impact on doctors' professional attitudes by drawing on persuasive communication techniques to enhance their credibility to demonstrate expertise, by building rapport and by making use of rational and emotional appeals.
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http://dx.doi.org/10.1186/s12909-020-1993-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077012PMC
March 2020

From the sticky floor to the glass ceiling and everything in between: protocol for a systematic review of barriers and facilitators to clinical academic careers and interventions to address these, with a focus on gender inequality.

Syst Rev 2020 02 10;9(1):26. Epub 2020 Feb 10.

Centre for Reviews and Dissemination, University of York, York, UK.

Background: Gender inequality within academic medicine and dentistry is a well-recognised issue, but one which is not completely understood in terms of its causes, or interventions to facilitate equality. This systematic review aims to identify, critically appraise, and synthesise the literature on facilitators and barriers to progression through a clinical academic career across medicine and dentistry. It will also explore interventions developed to increase recruitment and retention to clinical academic careers, with a particular focus on gender inequality.

Methods: The search will cover five databases (MEDLINE (including MEDLINE Epub Ahead of Print, MEDLINE In-Process & Other Non-Indexed Citations, and MEDLINE Daily), Cochrane Controlled Register of Trials (CENTRAL), PsycINFO, and Education Resource Information Center (ERIC)), reference lists, and forward citation searching. We will include studies of doctors, dentists, and/or those with a supervisory role over their careers, with or without an academic career. Outcomes will be study defined, but relate to success rates of joining or continuing within a clinical academic career, including but not limited to success in gaining funding support, proportion of time spent in academic work, and numbers of awards/higher education qualifications, as well as experiences of professionals within the clinical academic pathway. Study quality will be assessed using the Cochrane risk of bias tool for randomised controlled trials, the Newcastle-Ottawa tool for non-randomised studies, and the QARI tool for qualitative studies. Detailed plans for screening, data extraction, and analysis are provided within this protocol.

Discussion: This systematic review is situated within a larger project evaluating gender inequalities in clinical academic careers. This review will identify and synthetize barriers, facilitators, and interventions addressing gender inequalities in clinical academia. Our findings will increase awareness of inequalities in clinical academic careers through informing clinical academics, regulators and funders of the issues involved, and potential interventions to counteract these. Results will be published in a peer-reviewed journal.

Systematic Review Registration: Open Science Framework: https://osf.io/mfy7a.
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http://dx.doi.org/10.1186/s13643-020-1286-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011470PMC
February 2020

Realist evaluation of UK medical education quality assurance.

BMJ Open 2019 12 29;9(12):e033614. Epub 2019 Dec 29.

Research Department for Medical Education, UCL, London, UK

Objectives: The aim of the study was to explore what components of the General Medical Council's (GMC) Quality Assurance Framework work, for whom, in what circumstances and how?

Setting: UK undergraduate and postgraduate medical education and training.

Participants: We conducted interviews with a stratified sample of 36 individuals. This included those who had direct experiences, as well as those with external insights, representing local, national and international organisations within and outside medicine.

Intervention: The GMC quality assure education to protect patient and public safety utilising complex intervention components including meeting standards, institutional visits and monitoring performance. However, the context in which these are implemented matters. We undertook an innovative realist evaluation to test an initial programme theory. Data were analysed using framework analysis.

Results: Across components of the intervention, we identified key mechanisms, including transparent reporting to promote quality improvement; dialogical feedback; partnership working facilitating interactions between regulators and providers, and role clarity in conducting proportionate interventions appropriate to risk. The GMC's framework was commended for being comprehensive and enabling a broad understanding of an organisation's performance. Unintended consequences included confusion over roles and boundaries in different contexts which often undermined effectiveness.

Conclusions: This realist evaluation substantiates the literature and reveals deeper understandings about quality assuring medical education. While standardised approaches are implemented, interventions need to be contextually proportionate. Routine communication is beneficial to verify data, share concerns and check risk; however, ongoing partnership working can foster assurance. The study provides a modified programme theory to explicate how education providers and regulators can work more effectively together to uphold education quality, and ultimately protect public safety. The findings have influenced the GMC's approach to quality assurance which impacts on all medical students and doctors in training.
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http://dx.doi.org/10.1136/bmjopen-2019-033614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937024PMC
December 2019

Re-visioning Academic Medicine Through a Constructionist Lens.

Acad Med 2020 06;95(6):846-850

C.E. Rees was director, Monash Centre for Scholarship in Health Education (MCSHE), and director of curriculum (Medicine), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia, at the time this was written. She is now dean for research and innovation, College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, Western Australia, Australia; ORCID: http://orcid.org/0000-0003-4828-1422. P.E.S. Crampton is lecturer, Health Professions Education Unit, Hull York Medical School, York, Yorkshire, United Kingdom; ORCID: https://orcid.org/0000-0001-8744-930X. L.V. Monrouxe was associate dean for work integrated learning, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia, at the time this was written. She is now head of work integrated learning, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-4895-1812.

Constructionism in academic medicine matters. It encourages educators and researchers to question taken-for-granted assumptions, paying close attention to socially and historically contingent meanings. In this Invited Commentary, the authors explain what constructionism is; examine its ontological, epistemological, and axiological underpinnings; and outline its common methodologies and methods. Although constructivism favors the individual, constructionism privileges the social as the controlling force behind the construction of meaning. Where micro-constructionism attends to the minutiae of language, macro-constructionism focuses on broader discourses reproduced through material and social practices and structures. While social constructionists might situate themselves at any point on the relativist-realist continuum, many constructionists focus on constructionism as epistemology (the nature of knowledge) rather than ontology (the nature of reality). From an epistemological standpoint, constructionism asserts that how we come to know the world is constructed through social interaction. Constructionism thus values language, dialogue, and context, in addition to internal coherence between epistemology, methodology, and methods. Constructionism similarly values the concepts of dependability, authenticity, credibility, confirmability, reflexivity, and transferability. It also embraces the researcher-researched relationship. Given the privileging of language, qualitative methodologies and methods are key in constructionism, with constructionist-type questions focusing on how people speak. Here, the authors encourage the reader to develop an understanding of constructionism to re-vision academic medicine through a constructionist lens.
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http://dx.doi.org/10.1097/ACM.0000000000003109DOI Listing
June 2020

The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Acad Med 2020 06;95(6):947-957

K.C. Fragkos is clinical fellow in gastroenterology, University College London Hospitals, National Health Service Foundation Trust, London, United Kingdom; ORCID: https://orcid.org/0000-0002-7677-7989. P.E.S. Crampton is lecturer, Health Professions Education Unit, Hull York Medical School, York, United Kingdom, adjunct research fellow, University College London Medical School, London, United Kingdom, and adjunct research fellow, Monash Centre for Scholarship in Health Education, Monash University, Victoria, Australia; ORCID: https://orcid.org/0000-0001-8744-930X.

Purpose: Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect.

Method: The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses.

Results: The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics.

Conclusions: Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students.
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http://dx.doi.org/10.1097/ACM.0000000000003058DOI Listing
June 2020

Student dignity during work-integrated learning: a qualitative study exploring student and supervisors' perspectives.

Adv Health Sci Educ Theory Pract 2020 03 3;25(1):149-172. Epub 2019 Sep 3.

Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, Australia.

While University students increasingly participate in work-integrated learning (WIL), their dignity is often violated during WIL. The current literature is limited in so far as it typically focuses on student perspectives within healthcare contexts and does not use the concept of 'dignity'. Instead, this study explored student and supervisor perspectives on student dignity during WIL across healthcare and non-healthcare disciplines. Research questions included: What are: (1) types of student dignity experiences and patterns by groups; (2) factors contributing to experiences; (3) consequences of experiences? Sixty-five semi-structured interviews were conducted using narrative interviewing techniques with 30 supervisors and 46 students from healthcare (medicine, nursing and counselling) and non-healthcare (business, law and education) disciplines. Data were analyzed using framework analysis. Nine common narrative types were identified within 344 stories: verbal abuse, right for learning opportunities, care, inclusion, reasonable expectations, right for appropriate feedback, equality, trust, and right to be informed. Factors contributing to dignity experiences and consequences were often at the individual level (e.g. student/supervisor characteristics). We found some salient differences in perceptions of experiences between students and supervisors, but few differences between healthcare and non-healthcare disciplines. This study extends WIL research based on student perspectives in healthcare, and provides practice and further research guidance to enhance student dignity during WIL.
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http://dx.doi.org/10.1007/s10459-019-09914-4DOI Listing
March 2020

National licensing examinations: what are they good for?

Clin Teach 2020 06 26;17(3):323-325. Epub 2019 Aug 26.

Postgraduate Medical Education, University College London Medical School, London, UK.

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http://dx.doi.org/10.1111/tct.13083DOI Listing
June 2020

Setting priorities for health education research: A mixed methods study.

Med Teach 2019 09 29;41(9):1029-1038. Epub 2019 May 29.

Faculty of Medicine Nursing and Health Sciences, Monash Centre for Scholarship in Health Education, Monash University , Clayton , VIC , Australia.

Identifying priority research topics that meet the needs of multiple stakeholders should maximize research investment. To identify priorities for health education research. A three-stage sequential mixed methods study was conducted. Priorities for health education research were identified through a qualitative survey with 104 students, patients, academics, and clinicians across five health sciences and 12 professions (stage 1). These findings were analyzed using framework analysis and transposed into a quantitative survey whereby 780 stakeholders rated and ranked the identified priorities. Descriptive statistics identified priorities, exploratory factor analysis grouped priorities and differences between stakeholders were determined using Mann-Whitney tests (stage 2). Six individual or group interviews with 16 participants (stage 3) further explicated the results from previous stages. Of 30 priorities identified, the top were: how best to ensure students develop the required skills for work; how to promote resiliency and well-being in students; and ensuring the curriculum prepares students for work. For the majority of priorities, no significant differences were found between different stakeholder groups. These findings will be used to inform health educational research strategy both locally and nationally. Further research should explore if setting priorities can be translated effectively into education research policy and practice.
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http://dx.doi.org/10.1080/0142159X.2019.1612520DOI Listing
September 2019

Student and clinician identities: how are identities constructed in interprofessional narratives?

Med Educ 2019 08 15;53(8):808-823. Epub 2019 May 15.

Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.

Context: Although the literature on professional identity formation in medical education is increasing, it is scant by comparison on student and clinician identities within interprofessional contexts. We therefore adopt a novel discursive approach to identities to explore how soon-to-become graduates and workplace-based clinicians construct their own and others' identities in interprofessional student-clinician (IPSC) interaction narratives.

Methods: We conducted a qualitative narrative interview study with 38 students and 23 clinicians representing the fields of medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy. Through framework analysis, we identified the breadth of student and clinician identity constructions across 208 IPSC interaction narratives, and explored how common constructions differed by narrative and narrator. Through in-depth positioning analysis, we explored how student and clinician identities are discursively positioned within two selected IPSC interaction narratives.

Results: We identified 11 common constructions of student identities and eight common constructions of clinician identities across all 208 narratives. We found differences in identity constructions across positively versus negatively evaluated narratives, and student versus clinician narrators, highlighting the rhetorical nature of narratives. Our in-depth positioning analysis of two narratives illustrates how one student and one clinician discursively positioned theirs and others' identities during interprofessional interactions, and how identities vary depending on narrators' evaluations of their stories. Although both positioning analyses illustrate how the narrators' language serves to reproduce the common societal discourse of interprofessional conflict, the clinician narrative also draws on the competing discourse of interprofessional collaboration.

Conclusions: Although some of the identities support previous uniprofessional research, our findings illustrate greater breadth and depth in terms of student and clinician identities within interprofessional contexts. We encourage educators to embed identities curricula into existing workplace learning for students and clinicians to help them make sense of their developing professional and interprofessional identities. Workplace educators should facilitate meaningful IPSC interactions to promote interprofessional learning and collaboration.
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http://dx.doi.org/10.1111/medu.13886DOI Listing
August 2019

Introduction May 2019 - 'Really Good Stuff'.

Med Educ 2019 05;53(5):496-497

Chang Gung Memorial Hospital, Linkou, Taiwan.

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http://dx.doi.org/10.1111/medu.13869DOI Listing
May 2019

A postgraduate curriculum for integrated care: a qualitative exploration of trainee paediatricians and general practitioners' experiences.

BMC Med Educ 2019 Jan 7;19(1). Epub 2019 Jan 7.

Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF, UK.

Background: Integrated care unites funding, administrative, organisational, service delivery and clinical levels to create connectivity, alignment and collaboration within and between care delivery and prevention sectors. It aims to improve efficiency by avoiding unnecessary duplication of resources. Consequently, implementing integrated care is increasingly important; however, there are many barriers and how we teach healthcare practitioners to work across systems is under-researched. This paper explores an innovative educational curriculum, the Programme for Integrated Child Health (PICH).

Methods: The PICH involved an experiential learning approach supported by taught sessions on specific issues relevant to integrated care. A qualitative study was conducted by interviewing 23 participants using semi-structured one-to-one interviews. Participants included trainees (general practice, paediatrics) and programme mentors. Data was thematically analysed.

Results: Results are coded under three main themes: integrated care curriculum components, perceptions of a curriculum addressing integrated care and organisational change, and personal and professional learning. The data highlights the importance of real-world projects, utilising healthcare data, and considering patient perspectives to understand and develop integrated practices. Trainees received guidance from mentors but, more crucially learnt from, with, and about one another. They learnt about the context in which GPs and paediatricians work and developed a deeper understanding through which integrated services could be meaningfully developed.

Conclusions: This study explored participants' experiences and can be taken forward by educationalists to design curricula to better prepare healthcare practitioners to work collaboratively. The emergence of integrated care brings about challenges for traditional pedagogical approaches as learners have to re-align their discipline-specific approaches with evolving healthcare structures. PICH demonstrated that trainees acquired knowledge through real-word projects and experiential learning; and that this facilitated integration, empowering doctors to become leaders of organisational change. However, there are also many challenges of implementing integrated curricula which need to be addressed, including breaking down professional silos and integrating resourceful healthcare. This study begins to demonstrate the ability of an integrated curriculum to support trainees to work collaboratively, but further work is needed to develop the wider efficacy of the programme incorporating other professional groups, and to assess its longer term impact.
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http://dx.doi.org/10.1186/s12909-018-1420-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322273PMC
January 2019

What really matters for successful research environments? A realist synthesis.

Med Educ 2018 Jul 24. Epub 2018 Jul 24.

Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.

Context: Research environments, or cultures, are thought to be the most influential predictors of research productivity. Although several narrative and systematic reviews have begun to identify the characteristics of research-favourable environments, these reviews have ignored the contextual complexities and multiplicity of environmental characteristics.

Objectives: The current synthesis adopts a realist approach to explore what interventions work for whom and under what circumstances.

Methods: We conducted a realist synthesis of the international literature in medical education, education and medicine from 1992 to 2016, following five stages: (i) clarifying the scope; (ii) searching for evidence; (iii) assessing quality; (iv) extracting data, and (v) synthesising data.

Results: We identified numerous interventions relating to research strategy, people, income, infrastructure and facilities (IIF), and collaboration. These interventions resulted in positive or negative outcomes depending on the context and mechanisms fired. We identified diverse contexts at the individual and institutional levels, but found that disciplinary contexts were less influential. There were a multiplicity of positive and negative mechanisms, along with three cross-cutting mechanisms that regularly intersected: time; identity, and relationships. Outcomes varied widely and included both positive and negative outcomes across subjective (e.g. researcher identity) and objective (e.g. research quantity and quality) domains.

Conclusions: The interplay among mechanisms and contexts is central to understanding the outcomes of specific interventions, bringing novel insights to the literature. Researchers, research leaders and research organisations should prioritise the protection of time for research, enculturate researcher identities, and develop collaborative relationships to better foster successful research environments. Future research should further explore the interplay among time, identity and relationships.
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http://dx.doi.org/10.1111/medu.13643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120529PMC
July 2018

So, what are longitudinal community placements?

Clin Teach 2019 04 1;16(2):157-158. Epub 2018 May 1.

Research Department of Medical Education, University College London Medical School, London, UK.

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http://dx.doi.org/10.1111/tct.12793DOI Listing
April 2019

Understanding students' and clinicians' experiences of informal interprofessional workplace learning: an Australian qualitative study.

BMJ Open 2018 04 17;8(4):e021238. Epub 2018 Apr 17.

Department of Community Emergency Health and Paramedic Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia.

Objectives: While postgraduate studies have begun to shed light on informal interprofessional workplace learning, studies with preregistration learners have typically focused on formal and structured work-based learning. The current study investigated preregistration students' informal interprofessional workplace learning by exploring students' and clinicians' experiences of interprofessional student-clinician (IPSC) interactions.

Design: A qualitative interview study using narrative techniques was conducted.

Setting: Student placements across multiple clinical sites in Victoria, Australia.

Participants: Through maximum variation sampling, 61 participants (38 students and 23 clinicians) were recruited from six professions (medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy).

Methods: We conducted 12 group and 10 individual semistructured interviews. Themes were identified through framework analysis, and the similarities and differences in subthemes by participant group were interrogated.

Results: Six themes relating to four research questions were identified: (1) conceptualisations of IPSC interactions; (2) context for interaction experiences; (3) the nature of interaction experiences; (4) factors contributing to positive or negative interactions; (5) positive or negative consequences of interactions and (6) suggested improvements for IPSC interactions. Seven noteworthy differences in subthemes between students and clinicians and across the professions were identified.

Conclusions: Despite the results largely supporting previous postgraduate research, the findings illustrate greater breadth and depth of understandings, experiences and suggestions for preregistration education. Educators and students are encouraged to seek opportunities for informal interprofessional learning afforded by the workplace.
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http://dx.doi.org/10.1136/bmjopen-2017-021238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905730PMC
April 2018

Junior doctor psychiatry placements in hospital and community settings: a phenomenological study.

BMJ Open 2017 Sep 27;7(9):e017584. Epub 2017 Sep 27.

Medical Education Faculty, Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK.

Objectives: The proportion of junior doctors required to complete psychiatry placements in the UK has increased, due in part to vacant training posts and psychiatry career workforce shortages, as can be seen across the world. The aim of this study was to understand the lived experience of a Foundation Year 1 junior doctor psychiatry placement and to understand how job components influence attitudes.

Design: The study was conducted using a cross-sectional qualitative phenomenological approach.

Setting: Hospital and community psychiatry department settings in the North East of England, UK.

Participants: In total, 14 Foundation Year 1 junior doctors were interviewed including seven men and seven women aged between 23 and 34 years. The majority had completed their medical degree in the UK and were White British.

Results: The lived experience of a junior doctor psychiatry placement was understood by three core themes: exposure to patient recovery, connectedness with others in the healthcare team and subjective interpretations of psychiatry. The experiences were moderated by instances of role definition, reaction to the specialty and the organisational fit of the junior doctor capacity in the specialty.

Conclusions: The study reinforces and adds to the literature by identifying connectedness as being important for both job satisfaction and morale, which is currently damaged within the junior doctor population. The study provides in-depth insights into the lived experience of psychiatry placements and can be taken forward by educationalists to ensure the placements are meaningful experiences for junior doctors by developing role definition, belonging, structure and psychiatric care responsibility.
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http://dx.doi.org/10.1136/bmjopen-2017-017584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623527PMC
September 2017

Collaborative relationships and learning in rural communities.

Med Educ 2015 Sep;49(9):852-4

Durham, UK.

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http://dx.doi.org/10.1111/medu.12784DOI Listing
September 2015

Learning in underserved UK areas: a novel approach.

Clin Teach 2016 Apr 26;13(2):102-6. Epub 2015 Jun 26.

Centre for Medical Education Research, Durham University, Durham, UK.

Background: There is an insufficient number of medical students intending to pursue general practitioner (GP) careers. The undergraduate curriculum has traditionally prioritised teaching in large hospital settings despite most National Health Service patient contact occurring in primary care. Primary care is faced with providing health care for an ageing population with high levels of co-morbidities. Patients who live in deprived areas suffer many disadvantages affecting their health and additionally tend to be underserved. Globally, there has been an initiative to provide medical students with extended clinical placements in rural and remote areas. These placements have identified many beneficial outcomes; however, little is known about placements in other underserved, deprived areas. This paper describes an innovative pilot programme to address these issues.

Context: The North East of England has a large proportion of the most deprived communities and worst health care outcomes in England. In Teesside, Phase 1 Medicine at Durham University provides the pre-clinical curriculum. Durham students then join Newcastle University for Phase 2 Medicine, the clinical years.

Innovation: The Difficult and Deprived Areas Programme (DDAP) places fourth-year students in general practice and community settings in post-industrial, deprived areas for 14 weeks, thus adopting and applying principles from rural initiatives (continuity and immersion) to other deprived settings. The DDAP allows students to learn about psychosocial determinants of health and to pursue community interests whilst gaining an excellent clinical grounding. There is an insufficient number of medical students intending to pursue general practitioner careers

Implications: The DDAP provides a model for educators seeking to implement initiatives in similar underserved, deprived settings, which may potentially alleviate GP workforce shortages.
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http://dx.doi.org/10.1111/tct.12385DOI Listing
April 2016

A systematic literature review of undergraduate clinical placements in underserved areas.

Med Educ 2013 Oct;47(10):969-78

Centre for Medical Education Research, Durham University, Durham, UK.

Context: The delivery of undergraduate clinical education in underserved areas is increasing in various contexts across the world in response to local workforce needs. A collective understanding of the impact of these placements is lacking. Previous reviews have often taken a positivist approach by only looking at outcome measures. This review addresses the question: What are the strengths and weaknesses for medical students and supervisors of community placements in underserved areas?

Methods: A systematic literature review was carried out by database searching, citation searching, pearl growing, reference list checking and use of own literature. The databases included MEDLINE, EMBASE, PsycINFO, Web of Science and ERIC. The search terms used were combinations and variations of four key concepts exploring general practitioner (GP) primary care, medical students, placements and location characteristics. The papers were analysed using a textual narrative synthesis.

Findings: The initial search identified 4923 results. After the removal of duplicates and the screening of titles and abstracts, 185 met the inclusion criteria. These full articles were obtained and assessed for their relevance to the research question; 54 were then included in the final review. Four main categories were identified: student performance, student perceptions, career pathways and supervisor experiences.

Conclusions: This review reflects the emergent qualitative data as well as the quantitative data used to assess initiatives. Underserved area placements have produced many beneficial implications for students, supervisors and the community. There is a growing amount of evidence regarding rural, underserved areas, but little in relation to inner city, deprived areas, and none in the UK.
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http://dx.doi.org/10.1111/medu.12215DOI Listing
October 2013
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