Bryan Burford

Group processes in medical education: learning from social identity theory.

Medical Education 2012: 46: 143–152

Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting

Objectives To examine the prevalence and impact of bullying behaviours between staff in the National Health Service (NHS) workplace, and to explore the barriers to reporting bullying. Design Cross-sectional questionnaire and semi-structured interview. Setting 7 NHS trusts in the North East of England. Participants 2950 NHS staff, of whom 43 took part in a telephone interview. Main outcome measures Prevalence of bullying was measured by the revised Negative Acts Questionnaire (NAQ-R) and the impact of bullying was measured using indicators of psychological distress (General Health Questionnaire, GHQ-12), intentions to leave work, job satisfaction and self-reported sickness absence. Barriers to reporting bullying and sources of bullying were also examined. Results Overall, 20% of staff reported having been bullied by other staff to some degree and 43% reported having witnessed bullying in the last 6 months. Male staff and staff with disabilities reported higher levels of bullying. There were no overall differences due to ethnicity, but some differences were detected on several negative behaviours. Bullying and witnessing bullying were associated with lower levels of psychological health and job satisfaction, and higher levels of intention to leave work. Managers were the most common source of bullying. Main barriers to reporting bullying were the perception that nothing would change, not wanting to be seen as a trouble-maker, the seniority of the bully and uncertainty over how policies would be implemented and bullying cases managed. Data from qualitative interviews supported these findings and identified workload pressures and organisational culture as factors contributing to workplace bullying. Conclusions Bullying is a persistent problem in healthcare organisations which has significant negative outcomes for individuals and organisations.

Preparedness for practice : the perceptions of medical graduates and clinical teams

Background: Earlier research indicated that medical graduates feel unprepared to start work, and that this varies with medical school. Aims: To examine the extent to which graduates from different UK medical schools differed in their perceptions of preparedness for practice, and compare their perceptions with those of clinical team members. Method: An anonymous questionnaire assessing perceptions of 53 aspects of preparedness was devised, and administered to the graduating cohorts of three medical schools: Newcastle (systems-based, integrated curriculum); Warwick (graduate-entry) and Glasgow (problem-based learning). In addition, a triangulating questionnaire was cascaded via ward managers to doctors, nurses and pharmacists who worked with new graduates in their first posts. Results: The response rate for the cohort questionnaire was 69% (479/698). The overall mean preparedness score was 3.5 (on a five-point scale), with no significant difference between schools. On individual items, there were large differences within each site, but smaller differences between sites. Graduates felt most prepared for aspects of working with patients and colleagues, history taking and examination. They felt least prepared for completing a cremation form, some aspects of prescribing, complex practical procedures and for applying knowledge of alternative and complementary therapies, and of the NHS. A total of 80 clinical team questionnaires were completed, similarly showing substantial variation within each site, but smaller differences between sites. Conclusions: New doctors feel relatively unprepared for a number of aspects of practice, a perception shared by their colleagues. Although medical school has some effect on preparedness, greater differences are common across sites. Differences may reflect hidden influences common to all the schools, unintended consequences of national curriculum guidance or common traits in the graduate populations sampled. Further research is needed to identify the causes.

Portfolio learning for foundation doctors: early feedback on its use in the clinical workplace.

Context  A learning portfolio was developed to support the development of trainee doctors piloting Foundation Programme prototypes across the Northern Deanery in 2004 and 2005. Trainee doctors and their educational supervisors were surveyed about their experiences of using the portfolio in the clinical workplace.

User perceptions of multi-source feedback tools for junior doctors

Medical Education 2010: 44 : 165–176

Newly qualified doctors’ perceptions of informal learning from nurses: implications for interprofessional education and practice

Abstract Newly qualified doctors spend much of their time with nurses, but little research has considered informal learning during that formative contact. This article reports findings from a multiple case study that explored what newly qualified doctors felt they learned from nurses in the workplace. Analysis of interviews conducted with UK doctors in their first year of practice identified four overarching themes: attitudes towards working with nurses, learning about roles, professional hierarchies and learning skills. Informal learning was found to contribute to the newly qualified doctors’ knowledge of their own and others’ roles. A dynamic hierarchy was identified: one in which a “pragmatic hierarchy” recognising nurses’ expertise was superseded by a “normative structural hierarchy” that reinforced the notion of medical dominance. Alongside the implicit learning of roles, nurses contributed to the explicit learning of skills and captured doctors’ errors, with implications for patient safety. The findings are discussed in relation to professional socialisation. Issues of power between the professions are also considered. It is concluded that increasing both medical and nursing professions’ awareness of informal workplace learning may improve the efficiency of education in restricted working hours. A culture in which informal learning is embedded may also have benefits for patient safety.

Evaluation of an established learning portfolio.

Background:  The trainee‐held learning portfolio is integral to the foundation programme in the UK. In the Northern Deanery, portfolio assessment is standardised through the Annual Review of Competence Progression (ARCP) process. In this study we aimed to establish how current trainees evaluate portfolio‐based learning and ARCP, and how these attitudes may have changed since the foundation programme was first introduced.

Validation of a multi-source feedback tool for use in general practice.

Feedback from colleagues and patients is a core element of the revalidation process being developed by the General Medical Council. However, there are few feedback tools which have been specifically developed and validated for doctors in primary care. This paper presents data demonstrating the reliability and validity of one such tool. The CFEP360 tool combines feedback from the Colleague Feedback Evaluation Tool (CFET) and the Doctors Interpersonal Skills Questionnaire (DISQ). The analysis of over 10 000 completed questionnaires presented here identifies that colleague feedback is essentially two-dimensional (i.e. clinical and non-clinical skills) and that patient feedback is one-dimensional. However, items from both scales also effectively predict combined global ratings, indicating that colleagues and patients are identifying similar levels of performance as accessed by the feedback. Doctors who receive low feedback scores may require further attention, meaning the feedback potentially has diagnostic value. Reliable feedback on this tool, as indicated by this analysis, requires 14 colleague responses and 25 patient responses, figures comparable to other MSF tools if CFEP360 is to be used for a high stakes performance evaluation and possible revalidation (generalisability statistic G> or =0.80). For lower stakes performance evaluations, such as personal development, responses from 11 colleagues and 16 patients will still return reliable results (G> or =0.70).

Are specialist registrars fully prepared for the role of consultant

The step-up from specialist registrar (SpR) to consultant has been acknowledged by doctors as being large. It can involve relatively sudden change, and can be both stressful and demanding.1,2 There is increasing pressure on available time for training, with shortened training programmes and fewer hours spent at work as a result of the European Working Time Directive.2,3 Medical education research has not fully addressed this transition or explored ways of improving it for the benefit of patients and doctors. Newly appointed consultants are more prepared for some aspects of their work than others. The quality of training in clinical skills is rated most positively, although even this has room for improvement.2,4 New consultants feel less well prepared for their management responsibilities than they do for clinical work,2,4,5 including self-management.6 Training and experience in handling complaints, dealing with difficult professional relationships, recruitment and disciplinary proceedings have also been identified as weaker areas of specialty training.5,6 Feeling inadequately trained in communication and management skills can impact on stress, burnout and the mental health of consultants.4,7 It is notable that two-thirds of cases referred to the National Clinical Assessment Service (NCAS) involved behavioural issues (including difficulties with colleagues), either on their own or in conjunction with other concerns.8 In the light of these issues, a research project was developed to determine the extent to which specialty training provides doctors with the skills they require when they become consultants.

Professionalism education should reflect reality: findings from three health professions

Despite a growing and influential literature, ‘professionalism’ remains conceptually unclear. A recent review identified three discourses of professionalism in the literature: the individual; the interpersonal, and the societal–institutional. Although all have credibility and empirical support, there are tensions among them.