Faye Gishen

Progress and divergence in palliative care education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning

Background: Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown. Aim: To investigate palliative care training at UK medical schools and compare with data collected in 2000. Design: An anonymised, web-based multifactorial questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000. Results: All continue to deliver mandatory teaching on ‘last days of life, death and bereavement’. Time devoted to palliative care teaching time varied (2000: 6–100 h, mean 20 h; 2013: 7–98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include ‘involvement in clinical areas’, participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students’ assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally. Conclusion: Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.

Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools

Background: A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools. Aims: To investigate the evolution and structure of palliative care teaching at UK medical schools. Design: Anonymised, web-based questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools. Results: The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1–16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%). Conclusion: Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.

Enabling honest reflection: A Review

Reflective practice provides a backbone to professionalism, a commitment to lifelong learning and competency‐based education in the form of reflective portfolios. Changes in health care culture have promoted a move towards openness and reflection on challenging clinical encounters.

An unusual case of malignant thymoma associated graft-versus-host disease.

A woman in her early 50s presented with recurrent severe chest infections. Investigations revealed a low white cell count and a diagnosis of autoimmune neutropenia was made. Subsequently, an infiltrating thymic tumour (mitoses only) in the absence of myasthenia gravis was found. She underwent radical surgery. When neutropenic, she complained of painful, swollen joints and soft tissues. She was started on steroids and immunosuppressants and her pain settled. The following year, she had local malignant recurrence confirmed on imaging. She declined chemotherapy or targeted somatostatin and opted for alternative therapies. She developed a microcytic anaemia and commenced erythropoietin. This coincided with the development of a painful expanded rib lesion, hypercalcaemia, and ascites. She remained unwell with periodical flares in disease affecting many different organs and continued to mount a significant immunological response to her thymic tumour, manifesting as biopsy proven graft-versus-host disease involving joints, skin and lungs. This has been a complex clinical case involving multiple specialities, including haematology, oncology, immunology, endocrinology and palliative medicine.

Medical Student Resilience: a symposium approach

There is growing evidence that the psychological well-being of medical students is in decline. 1 Many of us involved in medical education recognise that training can be challenging and can result in signifi cant psychological morbidity, including stress, depression and burnout. 1 Burnout is a state of emotional exhaustion, depersonalisation and reduced sense of personal accomplishment that appears to be growing in prevalence among medical and other health care students, 2 both in the UK and internationally. 3,4

Learning from interactions with prisoners

During my first clinical year of medical school I (IS) was asked to perform an initial assessment of a patient in the emergency department; what I did not know was that the patient was a prisoner, in handcuffs, and accompanied by prison officers. It was the first time I had been involved in a prisoner’s care, and the staff had little advice to offer apart from advising me to stay close to the door. When taking a history from the patient about analgesic use and alcohol intake, the patient and prison guards all laughed, as analgesics (unless prescribed) and alcohol are both prohibited in prison.

Celebrating diversity to promote and create inclusive curricula

What problems were addressed? Health professionals must develop the ability to critically evaluate recent articles in the academic literature. The journal club is an essential, well-recognised, traditional teaching method that is used all over the world in different fields. Traditionally, scientific papers are selected by teachers and one of a group of participants is chosen to present each paper to his or her colleagues. Unfortunately, participants often fail to read the papers and as a result the task is left to those who have prepared a presentation. Consequently, teachers are demotivated by the small numbers of participants who engage in subsequent discussions. What was tried? Several educational strategies that use gamification as a means of enhancing student motivation and engagement have been developed. However, few of these strategies have been reported with reference to journal club activities. We created a new type of journal club according to the concepts of gamification, in which a competition based on the knowledge acquired by reading the articles is initiated in place of a formal presentation. Firstly, two scientific papers are sent to all participants before the journal club meeting. The participants are required to prepare different questions about the content of the papers before the meeting. At the beginning of journal club, participants are randomly allocated into two groups. Differences in the level of expertise of medical students and residents are balanced across the groups. All the questions created are divided into two boxes, one for each group, respectively. The game begins. In each round, the facilitator draws a member and one question from one group, and a member from the other group to answer. The member who asked the question must state whether or not the answer is correct. The facilitator will decide: (i) whether the first answer is correct, and (ii) whether any revision is correct. If the question is correctly answered, the answering group wins a point. If the question is incorrectly answered, the member of the group that created the question is required to give an answer. If that answer is correct, that person’s group wins a point. The total number of questions is planned to guarantee that all members will participate. The winning group receives a box of good chocolate, whereas the losing team receives a box of cheap chocolate in a nod to the maxim that chocolate is always chocolate. The result of the game is published on Facebook. What lessons were learned? All of the medical teachers who acted as facilitators in the Journal Club Challenge believed that the motivation and engagement of participants improved. As the process of motivation and engagement is complex and multifactorial, health professionals struggle to cope with all the demands of the clinical environment, which can hinder engagement with pedagogical activities. We believe that our activity showed that studying can be fun and increased participation in the journal club. The impact of the gamification on participants’ knowledge and competitiveness is unknown. Using gamification as a teaching tool is well accepted, especially in new generations of health professionals.

Ensuring our future doctors are resilient

Medical schools need to do more to foster future practitioner wellbeing and resilience

Preparing future doctors for palliative care: views of course organisers

Background Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown. Objective To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction. Methods An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools. Results Data were obtained from all 30 UK medical schools. Organisers agreed/strongly agreed (=agreed) that their PC course was highly rated by students (26, 87%). 25 (83%) agreed their course ‘enabled misconceptions and fears about PC, death, dying and bereavement to be addressed’, ‘delivered quality PC training’ (23, 77%), ‘fulfilled General Medical Council requirements’ (19, 63%), ‘prepared students well to care for patients with PC/EOLC needs’ (18, 60%) and ‘enabled students to visit a hospice and see the role of doctors in caring for the dying’ (17, 57%). Concerns were limited capacity to accommodate students (agreed 20, 66%) and variability in teaching according to location (15, 50%). Most agreed their institution recognised PC training as important (22, 73%), they felt supported by colleagues (21, 70%) and experienced cooperation between stakeholders (20, 67%). All agreed that PC training was essential for undergraduates, while 29 (97%) supported inclusion of a hospice visit in the curriculum. 27 agreed that their role was satisfying (90%), 3 disagreed (10%). Conclusions Approximately two-thirds of organisers were generally positive about their PC course, institution and role. A minority expressed concerns; these may reflect suboptimal PC training at their medical school and poor preparation of new doctors.

Improving patient safety by enhancing raising concerns at medical school

BackgroundDoctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula.We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience.MethodsThe authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students (n = 363) as well as voluntary attendance focus groups (n = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers.ResultsThe authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum.ConclusionsMore research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.