Mandy Moffat

The remediation challenge: theoretical and methodological insights from a systematic review

Objectives  Remediation is usually offered to medical students and doctors in training who underperform on written or clinical examinations. However, there is uncertainty and conflicting evidence about the effectiveness of remediation. The aim of this systematic review was to synthesise the available evidence to clarify how and why remediation interventions may have worked in order to progress knowledge on this topic.

Taking context seriously : explaining widening access policy enactments in UK medical schools

Since the 1970s, the UK medical student body has become increasingly diverse in terms of gender, ethnicity and age, but not in socio‐economic background. This variance may be linked to large differences in how individual medical schools interpret and put into practice widening participation (WP) policy. However, attempts to theorise what happens when policy enters practice are neglected in medical education. We aimed to explore the dynamics of policy enactment to give a novel perspective on WP practices across UK medical schools.

Epidemiology teaching: student and tutor perceptions

There is concern that undergraduate medical students are not exposed to appropriate opportunities to learn and understand the fundamental principles of epidemiology. In this study the aim was to explore students’ and tutors’ perceptions of the epidemiology teaching in the first three years of the Aberdeen, UK, medical undergraduate curriculum, with particular reference to the teaching in the Community Course. The study adopted a qualitative approach: six individual interviews and two focus-group meetings with quota samples of medical students in the fourth year, and one focus-group meeting with a purposive sample of Community Course tutors. It was found that most students acknowledged difficulty in learning epidemiology because they perceive the topic to be dry, boring and difficult to understand. However, there is a dawning awareness that it is important and its relevance becomes more obvious to students as they progress through the medical course, especially if they have undertaken an intercalated BSc Medical Sciences degree. Students want practical and clinically relevant teaching. Most students are exam driven and will only make efforts to learn topics that are assessed. Tutors also find epidemiology to be difficult and want their teaching to be clinically relevant.

Prevalence of common chronic respiratory diseases in drug misusers: a cohort study.

BACKGROUND A randomised controlled trial of substance misuse indicated that many patients who use methadone have respiratory symptoms and/or are prescribed respiratory medications. There is little research in this area. AIMS To determine the prevalence of respiratory disease and prescriptions among drug misusers. METHODS This historical cohort study of drug misusers and matched controls analysed routinely collected primary care data. The prevalence of common chronic respiratory diseases, class and number of respiratory medications were examined. RESULTS The cohort of 18,570 patients (9,285 per group) was mostly male (64%, n=11,890) and aged 31-59 years (76%, n=14,060). After adjusting for age, gender, deprivation and smoking status, the results showed that more drug misusers than controls had a diagnosis of asthma or chronic obstructive pulmonary disease (17.1% vs. 10.9%; adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.46 to 1.77, and 2.4% vs. 0.8%; OR 1.86, 95% CI 1.42 to 2.44, respectively) and were prescribed more chronic respiratory medications: short-acting β(2)-agonists (16.4% vs. 7.9%; OR 2.00, 95% CI 1.80 to 2.22), long-acting β(2)-agonists (1% vs. 0.4%; OR 1.93, 95% CI 1.29 to 2.89), and inhaled corticosteroids (10.6% vs. 7.6%; OR 1.49, 95% CI 1.33 to 1.67). All differences were statistically significant (p<0.001). CONCLUSIONS Drug misusers have a significantly higher prevalence of respiratory diseases and respiratory prescriptions than matched controls. Further work is needed to determine the reasons for this.

Core competencies in teaching and training for doctors in Scotland: a review of the literature and stakeholder survey

Abstract Background: The UK General Medical Council requires all registered doctors to be competent in all areas of their work, including teaching and training. Aims: The current research sought consensus on core competencies for all consultants and GPs involved in teaching and training in Scotland. Method: A draft list of 80 competencies was developed from the literature and made available as a survey to all consultants and GPs with teaching roles and all final year speciality trainees working in Scotland. Respondents rated the importance of each competency and provided free text comments. Results: There were 1026 responses. Eighteen competencies were rated as “high priority”, and are recommended as a baseline for all doctors involved in teaching and training; 55 were rated as “medium priority”, and are recommended in relation to specific teaching and training roles; and 7 were rated as “low priority”. Free text responses suggested the topic was controversial and emotive, and emphasised the importance of further work to engage trainers. Conclusions: The findings appeared to have face validity, and it was felt these could be used as the basis for developing a “Scottish Trainer Framework” for doctors and others involved in teaching and training in Scotland.

Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

Background:Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs).Aim:To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients.Methods:A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced.Results:Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients’ inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care.Conclusions:Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption.

Using databases in medical education research: AMEE Guide No. 77

This AMEE Guide offers an introduction to the use of databases in medical education research. It is intended for those who are contemplating conducting research in medical education but are new to the field. The Guide is structured around the process of planning your research so that data collection, management and analysis are appropriate for the research question. Throughout we consider contextual possibilities and constraints to educational research using databases, such as the resources available, and provide concrete examples of medical education research to illustrate many points. The first section of the Guide explains the difference between different types of data and classifying data, and addresses the rationale for research using databases in medical education. We explain the difference between qualitative research and qualitative data, the difference between categorical and quantitative data, and the difference types of data which fall into these categories. The Guide reviews the strengths and weaknesses of qualitative and quantitative research. The next section is structured around how to work with quantitative and qualitative databases and provides guidance on the many practicalities of setting up a database. This includes how to organise your database, including anonymising data and coding, as well as preparing and describing your data so it is ready for analysis. The critical matter of the ethics of using databases in medical educational research, including using routinely collected data versus data collected for research purposes, and issues of confidentiality, is discussed. Core to the Guide is drawing out the similarities and differences in working with different types of data and different types of databases. Future AMEE Guides in the research series will address statistical analysis of data in more detail.