Lorraine M Noble

Change in attitudes to psychiatry and intention to pursue psychiatry as a career in newly qualified doctors: a follow-up of two cohorts of medical students

This follow-up study of 234 doctors examined whether improvements in attitudes to psychiatry following an undergraduate psychiatry attachment were maintained after graduation, and explored the relationship between attitudes to psychiatry and intention to pursue psychiatry as a career. Improvements in attitudes following undergraduate psychiatric attachment decayed over time but remained higher than pre-attachment levels. Attitudes of doctors who definitely intended to pursue psychiatry, however, increased at each stage. Attitudes of doctors were predicted by post-attachment attitudes, which in turn were predicted by encouragement from consultants and influences of specialist registrars during the attachment at medical school. There were no differences between a problem-based and a traditional psychiatry curriculum in attitude change. The findings suggest that encouragement during medical school from more senior doctors increases the numbers wanting to pursue psychiatry and may increase the number who subsequently pursue psychiatry as a career.

Shortage specialties: changes in career intentions from medical student to newly qualified doctor.

There is currently a shortage of doctors in Britain, especially in general practice, psychiatry and pathology. This study aimed to examine whether career intention, especially in the shortage specialties, changes between undergraduate level and graduation. The 234 participants were Senior House Officers and Pre-Registration House Officers, who had provided information about their career intentions in their fourth year of medical school. Participants completed a postal questionnaire about their current career intentions. 38.9% of medical students rising to 63.3% of doctors definitely intended to pursue a particular specialty. While the numbers of people who definitely wanted to pursue general practice and psychiatry increased, in line with nearly all other specialties, the overall attractiveness of these shortage specialties fell. Early career advice and support during medical school and immediately after graduation may help doctors to be confident in pursuing shortage specialties to which they were originally attracted.

Travel clinic consultation and risk assessment.

A significant number of travellers sustain travel-related injury or illness, despite receiving pretravel advice. This appears to be due to a combination of inconsistent guidance about risks and recommendations, and partial adherence. This article considers perceptions and attitudes to risk, factors affecting uptake of advice, and features of an effective consultation. A framework is proposed for a pretravel consultation, using a shared decision-making approach. Engaging the traveller as an active participant in maintaining their own health and providing balanced, evidence-based information about risks and benefits is predicted to enhance the effectiveness of the pretravel consultation.

Explicitly linking teaching and assessment of communication skills

Background: Communication skills teaching is known to be effective, but students feel there are discrepancies between how communication skills are taught and how they are assessed. Aims: This study examined the effect of using standard assessment criteria during communication skills teaching on students’ performance in an end-of-year summative OSCE. Method: Students attending their year 3 communication skills teaching were randomised to one of the following three conditions: the assessment criteria were available for reference on the medical school website; or students received the assessment criteria for use in the discussion and feedback; or each students performance was graded by him- or her- self, his or her peers, the tutor and the actor using the standard assessment criteria. Results: There was no significant difference in the end-of-year OSCE performance of students who received the three different conditions. Actively using standard assessment criteria during teaching did not therefore improve OSCE performance. There were low but significant correlations between the tutors’ assessment and the students’ self-assessment and between the tutors’ assessment and the peer groups assessment. Conclusion: The congruence between observers in the assessments of role-played consultations using the standard assessment criteria indicates that the criteria may be helpful for summarizing feedback to students.

Travel clinic communication and non-adherence to malaria chemoprophylaxis *

Many travellers fail to take malaria chemoprophylaxis, despite receiving pre-travel advice. This study examined whether non-adherence could be predicted from verbal communication in the pre-travel consultation, and whether non-adherence was related to the quality of clinician-traveller communication. The consultations of one hundred and thirty consecutive travellers at a UK travel clinic were audiotaped and a follow-up telephone interview was used to assess adherence to malaria chemoprophylaxis. Experienced travel clinic staff were asked to predict adherence and rate the quality of communication from eighteen transcripts of consultations (nine good and nine poor adherence). Clinic staff predicted adherence to malaria chemoprophylaxis significantly better than chance. Poor adherence was related to poor quality communication. Clinic staff provided criteria for good quality clinician-traveller communication. It is concluded that predictors of non-adherence can be identified during the pre-travel consultation. Clinic staff could employ specific communication strategies to improve the effectiveness of consultations.

Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

BackgroundTo evaluate NHS England London region’s approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice.MethodsA pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation.ResultsThe central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer’s practice by providing an ‘outsider perspective’. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement.ConclusionsResponsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.

Communication skills teaching – current needs

S ince the early 1990s, communication skills teaching has become firmly embedded within the medical curriculum. Undergraduate programmes are driven by Tomorrow’s Doctors and Good Medical Practice, which emphasise the role of communication as a core component of professionalism. At postgraduate level, the Royal Colleges of Physicians and Surgeons formally introduced OSCE-style assessments of communication some years ago, general practitioners (GPs) have been using video review for even longer, and now Modernising Medical Careers is focusing attention on the communication skills needed by newly qualified doctors. While research evidence continues to grow regarding the importance of communication to outcomes of care, national policies (for example, The NHS Plan) highlight common problems to be addressed, such as the ubiquitous finding that patients want more information and involvement in decision-making.

Consensus statement on an updated core communication curriculum for UK undergraduate medical education

OBJECTIVES Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine. METHOD The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education. RESULTS The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed. CONCLUSION Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula. PRACTICE IMPLICATIONS The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources.

Travel-associated infections in Europe.

www.thelancet.com/infection Vol 15 August 2015 879 Diseases with severe presentation are probably not captured by travel clinics. For example, most patients with travel-associated Legionnaires’ disease—a disorder with a substantial risk for European travellers—are directly admitted to hospitals. Travel-associated infections in migrants are complex for various reasons. Epidemiology can be affected by changing trends in the migrant’s country of origin, such as those with HIV originating from subSaharan countries. Destination of travel, exposure and risk behaviours while travelling, and health-seeking behaviour on return might differ between affluent tourists and migrants with low income visiting relatives. First, it is essential to determine the representativeness of migrants attending travel clinics compared with all migrants living in Europe. Second, specifi cities in terms of destination or diseases should be reported. Last, I would question the inclusion of patients whose only purpose of travel was to emigrate to Europe, since these migrants would have been out of reach of prevention strategies. The Comment by Eskild Petersen and Lin Hwei Chen published alongside the Article pointed out the lack of denominator data as the main limitation of the study. I would suggest to use available data on tourism patterns (eg, Eurostat or the UN World Tourism Organization) for further analyses.