Nicola Brennan

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors.

Medical Education 2010: 44: 449–458

Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor

Background: Undergraduate medicine curricula can be designed to enable smoother transition to work as a junior doctor. Evaluations should improve curriculum design. Aim: To compare a graduate cohort from one medical school with a cohort from other medical schools in the same Foundation Year 1 (FY1) programme in terms of retrospective perceptions of readiness for practice. Method: A Likert-scale questionnaire measured self-perception of readiness to practice, including general capabilities and specific clinical skills. Results: Response rate was 74% (n = 146). The Peninsula Medical School cohort reported readiness for practice at a significantly higher level than the comparison cohort in 14 out of 58 items (24%), particularly for ‘coping with uncertainty’. In only one item (2%) does the comparison cohort report at a significantly higher level. Conclusions: Significant differences between cohorts may be explained by undergraduate curriculum design, where the opportunity for early, structured work-based, experiential learning as students, with patient contact at the core of the experience, may promote smoother transition to work as a junior doctor. Evaluation informs continuous quality improvement of the curriculum.

A systematic review of educational interventions to change behaviour of prescribers in hospital settings, with a particular emphasis on new prescribers.

Prescribing is a complex task and a high risk area of clinical practice. Poor prescribing occurs across staff grades and settings but new prescribers are attributed much of the blame. New prescribers may not be confident or even competent to prescribe and probably have different support and development needs than their more experienced colleagues. Unfortunately, little is known about what interventions are effective in this group. Previous systematic reviews have not distinguished between different grades of staff, have been narrow in scope and are now out of date. Therefore, to inform the design of educational interventions to change prescribing behaviour, particularly that of new prescibers, we conducted a systematic review of existing hospital‐based interventions.

Understanding how appraisal of doctors produces its effects: a realist review protocol.

Introduction UK doctors are now required to participate in revalidation to maintain their licence to practise. Appraisal is a fundamental component of revalidation. However, objective evidence of appraisal changing doctors’ behaviour and directly resulting in improved patient care is limited. In particular, it is not clear how the process of appraisal is supposed to change doctors’ behaviour and improve clinical performance. The aim of this research is to understand how and why appraisal of doctors is supposed to produce its effect. Methods and analysis Realist review is a theory-driven interpretive approach to evidence synthesis. It applies realist logic of inquiry to produce an explanatory analysis of an intervention that is, what works, for whom, in what circumstances, in what respects. Using a realist review approach, an initial programme theory of appraisal will be developed by consulting with key stakeholders in doctors’ appraisal in expert panels (ethical approval is not required), and by searching the literature to identify relevant existing theories. The search strategy will have a number of phases including a combination of: (1) electronic database searching, for example, EMBASE, MEDLINE, the Cochrane Library, ASSIA, (2) ‘cited by’ articles search, (3) citation searching, (4) contacting authors and (5) grey literature searching. The search for evidence will be iteratively extended and refocused as the review progresses. Studies will be included based on their ability to provide data that enable testing of the programme theory. Data extraction will be conducted, for example, by note taking and annotation at different review stages as is consistent with the realist approach. The evidence will be synthesised using realist logic to interrogate the final programme theory of the impact of appraisal on doctors’ performance. The synthesis results will be written up according to RAMESES guidelines and disseminated through peer-reviewed publication and presentations. Trial registration number The protocol is registered with PROSPERO 2014:CRD42014007092.

Interventions to improve antimicrobial prescribing of doctors in training: the IMPACT (IMProving Antimicrobial presCribing of doctors in Training) realist review

Introduction Antimicrobial resistance has been described as a global crisis—more prudent prescribing is part of the solution. Behaviour change interventions are needed to improve prescribing practice. Presently, the literature documents that context impacts on prescribing decisions, yet insufficient evidence exists to enable researchers and policymakers to determine how local tailoring should take place. Doctors in training are an important group to study, being numerically the largest group of prescribers in UK hospitals. Unfortunately very few interventions specifically targeted this group. Methods and analysis Our project aims to understand how interventions to change antimicrobial prescribing behaviours of doctors in training produce their effects. We will recruit a project stakeholder group to advise us throughout. We will synthesise the literature using the realist review approach—a form of theory-driven interpretive systematic review approach often used to make sense of complex interventions. Interventions to improve antimicrobial prescribing behaviours are complex—they are context dependent, have long implementation chains, multiple non-linear interactions, emergence and depend on human agency. Our review will iteratively progress through 5 steps: step 1—Locate existing theories; step 2—Search for evidence; step 3—Article selection; step 4—Extracting and organising data; and step 5—Synthesising the evidence and drawing conclusions. Data analysis will use a realist logic of analysis to describe and explain what works, for whom, in what circumstances, in what respects, how and why to improve antimicrobial prescribing behaviour of doctors in training. Ethics and dissemination Ethical approval was not required for our review. Our dissemination strategy will be participatory and involve input from our stakeholder group. Tailored project outputs will be targeted at 3 audiences: (1) doctors in training; (2) clinical supervisors/trainers and medical educators; and (3) policy, decision makers, regulators and royal societies.

Towards an understanding of how appraisal of doctors produces its effects: a realist review

Revalidation was launched in the UK to provide assurances to the public that doctors are up to date and fit to practice. Appraisal is a fundamental component of revalidation. Approximately 150 000 doctors are appraised annually, costing an estimated £97 million over 10 years. There is little understanding of the theory of how and why appraisal is supposed to produce its effects. A realist review of the literature was utilised to explore these issues, as they generate context‐mechanism‐outcome (CMO) configurations, resulting in the creation of theories of how and why appraisal of doctors produces its effects.

The spatiality of Irish manufacturing linkages in the ‘Celtic Tiger’ era

Manufacturing investment from abroad has been of immense importance to Ireland’s economic development in recent decades. In particular, high levels of foreign investment in manufacturing were the main contributor to the unprecedented economic growth rates from the early 1990s which led to Ireland’s economy being compared with the Asian ‘Tigers’. Clearly it is desirable from a national economic point of view that the current base of foreign manufacturing firms should remain as embedded as possible. In this respect, the low level of local linkages developed by foreign firms has been a constant concern for policymakers. A number of studies have been conducted on the nature of linkages developed within the Irish economy by foreign-owned manufacturing plants in terms of the nature of these linkages and their potential for further development. However, there has been little research on the spatial patterns of external linkages of the plants in question. Based on a survey of 91 firms in four key manufacturing sectors, this paper examines the spatial configuration of the material input linkages of Irish manufacturing industry. The findings show that major sectoral variations exist in the spatiality of the linkage structures of Irish manufacturing industry. The paper concludes with a discussion of the possible implications of these variations for the future stability and embeddedness of manufacturing firms in the Irish economy.

Exploring the Map of Medicine's potential in undergraduate medical education.

Background: Map of Medicine is a web-based knowledge resource depicting evidence-based pathways of patient care. Recent publications suggest a possible role for the Map of Medicine as a training tool in postgraduate education. Aim: The aim of this study was to explore the potential of the Map of Medicine to enhance undergraduate medical education. Methods: A mixed-method study including a survey of UK medical schools, and the embedding of the resource at one medical school and the evaluation of its impact. Results: The survey found that only 1 of 23 medical schools was using the Map of Medicine in its undergraduate curriculum. The Peninsula Medical School students’ reaction to the resource was extremely positive. Students liked the Map of Medicines navigability and help in accessing reliable information. Use of the resource by students grew steadily throughout the period of the study and peaked at 595 sessions a month. There was evidence that usage was directly linked to curricular events, particularly problem-based learning tutorials and medical knowledge assessments. Conclusion: There is clear potential for the Map of Medicine in undergraduate medical education and a short-active period of resource promotion led to its embedding within routine learning practice.

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors

Medical Education 2010: 44: 449–458

The transition from medical student to junior doctor

Medical Education 2010: 44: 449–458