Beverley Lucas

Developing a learning culture: twelve tips for individuals, teams and organizations

A culture of learning in providing health services and education for health professionals is a constant challenge for individuals, team and organizations. The importance of such a culture was highlighted by the findings of the Bristol Royal Infirmary Inquiry (). This was discussed in the context of the literature on the Learning Organization (Senge, ) at the 2004 Association of Medical Education in Europe (AMEE) conference, and reviewed a year later at the 2005 AMEE conference. This paper outlines twelve tips for educational and health service organizations in facilitating a culture of learning for their members and also offers specific advice to individual students and professionals.

Lost in translation: using bilingual simulated patients to improve consulting across language barriers.

In the light of rapid demographic change and increased globalisation of health, ways to consult effectively across language barriers are increasingly important. This article describes the development, organisation and evaluation of a UK workshop designed to develop the skills of undergraduate medical students consulting with patients with limited English proficiency, using specially recruited and trained bilingual simulated patients. The authors discuss the advantages and areas for development of the approach, before considering possible future developments.

What are the key elements of a primary care teaching practice

This paper explores the perceptions of clinicians, clinical learners and practice staff of key elements of being a teaching practice. Whilst previous studies have explored individual facets of being a teaching practice, this paper offers an in-depth insight of how these elements come together to support learning and teaching activity. The single descriptive case study was conducted within a purposefully selected primary care teaching practice in West Yorkshire, UK. Interview, observational and documentary data were collected over a single academic year in 2008/9. Interview data from 33 participants were transcribed and analysed using a modified grounded theory approach. Those interviewed included transient, vocational and embedded medical and nurse learners. The findings are presented within the context of existing literature on teaching practices and practice-based clinical learning. The case study highlighted elements that support and contribute to learning within a practice. These elements include: whole practice support for learning, a skilled and committed clinical and educational workforce, stimulation and support from a range of learners at all levels, and a more indefinable additional element which is best summarised as a passion for education. The findings will be of interest to those involved with the delivery or organisation of clinical learning in primary care.

Patients’ experiences with home parenteral nutrition: a literature review

Aim The aim of this review is to summarise the literature relating to patients’ experiences with home parenteral nutrition (HPN). Method This literature review is based on searches of CINAHL, PubMed, Web of Knowledge and Web of Science for articles published between 1970 and 2013. Additional studies were included from Department of Health publications, NICE clinical guidance, UK patient support group with interests in HPN or intestinal failure (IF). Results Patients with severe IF have been successfully treated with HPN since the 1970s. Early published studies evaluated clinical outcomes such as catheter-related infections, metabolic complications, thrombosis of the catheterised vein and liver impairment. Since the 1980s questionnaire studies were used to evaluate the quality of life (QoL) of patients treated with HPN. These early studies used QoL assessment tools which were not validated for patients treated with HPN. Internationally, there were published qualitative research studies which explored the experiences of patients treated with HPN. Conclusions The long-term outcome of patients treated with HPN continues to attract research interest. The review of the literature did not identify any published qualitative studies on the experiences of patients treated with HPN in the UK, suggesting a gap in the research. The UK National Health Service advocates a patient-centred approach for service design and delivery in primary and secondary care. This literature review has highlighted opportunities for qualitative research into the experiences of patients living with HPN to achieve better understanding and awareness of the rehabilitation of these patients.

Using Problem-Based Learning in Primary Care: What do Undergraduates on Traditional Medical Courses Make of It?

This project explored the experiences and perceptions of medical students taught in primary care using a problem-based learning (PBL) approach, within the context of a conventional (non-PBL) curriculum. Four independently moderated focus group interviews were undertaken with a total of 15 final year undergraduate medical students from the University of Leeds, England, immediately after experiencing a four week PBL-based clinical attachment in a primary care setting. Medical students exposed to a PBL module within a non-PBL curriculum appreciated the opportunity for deeper learning, gaining understanding of course material and retaining knowledge. They considered the PBL approach acceptable within isolated modules, and relevant for clinical practice. They exposed tensions between their perceived needs for superficial learning for medical finals and the perceived strengths of the PBL approach. Isolated use of PBL-based teaching in a non-PBL curriculum appears acceptable to medical students and was considered to Education for Primary Care (2007) 18: 450–58 # 2007 Radcliffe Publishing Limited

GP tutor opinions on quality criteria generated for undergraduate education in primary care: a practice-based educational evaluation.

This study explores GP tutor views of a nationally derived list of quality criteria for undergraduate and postgraduate practice-based teaching. Whilst these published criteria provided a means of benchmarking locally, an evaluation of utility in practice required further exploration. This educational evaluation was conducted within a West Yorkshire locality as a means of supporting their practice-based primary care education. A survey approach using an online Likert scaled questionnaire was distributed to all GP tutors with an additional opportunity for free text qualitative comments. Data were analysed using an online reporting package for survey results (MarketSight) and thematic analysis of qualitative data. Key findings were that in general all the criteria were rated having a high level of importance with 83% of GPs claiming they would find such a list important in directing their learning and teaching approach. The opinions on out-of-hours experiences for medical students were also interesting as they differed greatly. These findings will be of interest to those involved in the organisation and delivery of medical education within primary care as the list of criteria could act as a structural guide for directing medical student teaching, learning and its quality assurance. Implications for further research include the utility of core criteria and the exploration of out-of-hours experience for medical student education.

Patients' experiences with home parenteral nutrition: A grounded theory study

BACKGROUND & AIMS Parenteral nutrition (PN) provides nourishment and hydration as an intravenous infusion to patients with intestinal failure (IF). The aim of the study is to generate theory that explains the experiences of adult patients living with home parenteral nutrition (HPN) and complex medication regimens. METHODS A grounded theory methodology was used to explore the experiences of twelve patients receiving HPN. A semi-structured interview was conducted and recorded in each participants home setting. Each interview was transcribed verbatim. The simultaneous process of data collection and analysis was followed reflecting the principles of the constant comparative approach. RESULTS A total of 15 patients gave written consent, with 12 of them agreeing to be interviewed. All the participants had previously undergone surgery as a result of chronic ill health or sudden illness. Analysis revealed two core categories: stoma and HPN, and these were supported by the subcategories: maintaining stoma output, access to toilets, managing dietary changes, maintaining the HPN infusion routine, access to technical help to set up an HPN infusion, mobility with HPN equipment and general health changes. The strategy of living with loss was demonstrated by all the participants, and this was supported by the action strategies of maintaining daily activities and social interactions. CONCLUSIONS This study generates new understanding and insight into the views and experiences of patients receiving HPN in the UK. The findings from these participants have been shown to resonate with the Kubler-Ross Model [1] of the five stages of grief. The theory of living with loss was generated by the use of a grounded theory methodology. This small scale exploratory study reveals opportunities for improvements in practice to be considered by the nutrition support team (NST) and other healthcare professionals involved in the patients hospital stay prior to discharge on HPN.

Perceptions of UK General Practice Specialty Registrars on Professionalism: A Qualitative Study

A review of the literature of medical professionalism identified key features of altruism, service, and accountability including self-regulation, respect and lifelong learning. Contemporary healthcare developments within the United Kingdom reflect societal changes including egalitarianism and consumerism, importance of the patient viewpoint, new interprofessional relationships and patient choice. Recent challenges to professionalism within the prevailing socio-political context include changes to GP working practices with limited evidence of how specialty registrars (StRs) view professionalism within the context of such change. Education for Primary Care (2008) 19: 481–95 # 2008 Radcliffe Publishing Limited