Rakesh Patel

The struggling student: a thematic analysis from the self-regulated learning perspective.

Students who engage in self‐regulated learning (SRL) are more likely to achieve academic success compared with students who have deficits in SRL and tend to struggle with academic performance. Understanding how poor SRL affects the response to failure at assessment will inform the development of better remediation.

The importance of educational theories for facilitating learning when using technology in medical education

Abstract Background: There is an increasing use of technology for teaching and learning in medical education but often the use of educational theory to inform the design is not made explicit. The educational theories, both normative and descriptive, used by medical educators determine how the technology is intended to facilitate learning and may explain why some interventions with technology may be less effective compared with others. Aims: The aim of this study is to highlight the importance of medical educators making explicit the educational theories that inform their design of interventions using technology. Method: The use of illustrative examples of the main educational theories to demonstrate the importance of theories informing the design of interventions using technology. Results: Highlights the use of educational theories for theory-based and realistic evaluations of the use of technology in medical education. Conclusion: An explicit description of the educational theories used to inform the design of an intervention with technology can provide potentially useful insights into why some interventions with technology are more effective than others. An explicit description is also an important aspect of the scholarship of using technology in medical education.

A systematic review of approaches for calculating the cost of medication errors

Introduction Although medication errors may cause significant morbidity and mortality, the true cost of avoidable harm from such errors is unclear. While studies describe different methods for calculating a financial cost from an error, there remains variability in the way calculations are conducted depending on the clinical context. This review aimed to investigate the range of approaches for calculating medication error costs across healthcare settings. Methods A systematic review was carried out with a duplicate data extraction approach and mixed methods data synthesis. Medline, Embase and Web of Science were searched for studies published between 1993 and 2015. Studies that explicitly described a method for calculating medication error cost were included. The variables used for the calculations and a description of the approach for calculating errors were reported. Results 21 studies were included in the final review. There was wide variation in the way calculations were undertaken, with some calculations using a single variable only and others using several variables in a multistep approach. Few calculations included indirect costs, such as loss of earnings for the patient, and only one calculation considered opportunity cost. The majority of studies presented direct medication error costs whereas others approximated error costs from the savings made following an intervention. Conclusions There are a wide range of methods used for calculating the cost of medication errors. The diversity arises from the number of variables used in calculations, the perspective from which the calculation is conducted from, and the degree of economic rigour applied by researchers.

Self-regulated learning: the challenge of learning in clinical settings.

2012;46:447–53. 7 McRobert AP, Causer J, Vassiliadis J, Watterson L, Kwan J, Williams AM. Contextual information influences diagnosis accuracy and decision making in simulated emergency medicine emergencies. BMJ Qual Saf 2013;22 (6):478–84. 8 Cauraugh JH, Martin M, Martin KK. Modelling surgical expertise for motor skill acquisition. Am J Surg 1999;177 (4):331–6. 9 Ericsson KA, Starkes JL, eds. Expert Performance in Sport. Advances in Research on Sport Expertise.Champaign, IL: Human Kinetics 2003. 10 Ericsson KA, Krampe RT, TeschR€ omer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100 (3):363–406. 11 Causer J, Williams AM. Professional expertise in medicine. In: Lanzer P, ed. Catheter-based Cardiovascular Interventions – Knowledge-based Approach. New York, NY: Springer 2012;97–112.

Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement

Background Clinical decision support (CDS) tools improve clinical diagnostic decision making and patient safety. The availability of CDS to health care professionals has grown in line with the increased prevalence of apps and smart mobile devices. Despite these benefits, patients may have safety concerns about the use of mobile devices around medical equipment. Objective This research explored the engagement of junior doctors (JDs) with CDS and the perceptions of patients about their use. There were three objectives for this research: (1) to measure the actual usage of CDS tools on mobile devices (mCDS) by JDs, (2) to explore the perceptions of JDs about the drivers and barriers to using mCDS, and (3) to explore the perceptions of patients about the use of mCDS. Methods This study used a mixed-methods approach to study the engagement of JDs with CDS accessed through mobile devices. Usage data were collected on the number of interactions by JDs with mCDS. The perceived drivers and barriers for JDs to using CDS were then explored by interviews. Finally, these findings were contrasted with the perception of patients about the use of mCDS by JDs. Results Nine of the 16 JDs made a total of 142 recorded interactions with the mCDS over a 4-month period. Only 27 of the 114 interactions (24%) that could be categorized as on-shift or off-shift occurred on-shift. Eight individual, institutional, and cultural barriers to engagement emerged from interviews with the user group. In contrast to reported cautions and concerns about the impact of clinicians’ use of mobile phone on patient health and safety, patients had positive perceptions about the use of mCDS. Conclusions Patients reported positive perceptions toward mCDS. The usage of mCDS to support clinical decision making was considered to be positive as part of everyday clinical practice. The degree of engagement was found to be limited due to a number of individual, institutional, and cultural barriers. The majority of mCDS engagement occurred outside of the workplace. Further research is required to verify these findings and assess their implications for future policy and practice.

Medical education research should extend further into clinical practice

The ultimate purpose of medical education is to develop a workforce to provide and improve patient care.1-3 This is both a teleological and deontological stance.4 A key determinant of good medical education research, from either of these perspectives, therefore, is the potential to generate new understandings of, and practices concerning, education directed at improving patient care. This argument is neither new nor groundbreaking, having been articulated by medical education researchers in previous years.5, 6 However, relative lack of success in linking learner outcomes with patient impact (e.g. experience, clinical effectiveness and improved safety) perpetuates the idea that it is not possible to ‘close the education loop’.

What can medical educators learn from the Rio 2016 Olympic Games

Abstract Medical Educators face an ongoing challenge in optimizing preparedness for practice for newly qualified doctors. Junior doctors have highlighted specific areas in which they do not feel adequately equipped to undertake their duties, including managing the acutely unwell patient. In these highly stressful, time-critical scenarios it might be assumed that a lack of knowledge underpins these feelings of apprehension from junior medics; however, having studied, trained and passed examinations to demonstrate such knowledge, perhaps other factors should be considered. The recent Olympic Games in Rio demonstrated the impact of sport psychology techniques in allowing athletes to achieve their optimum performance in the face of adversity. The use of mental and behavioral strategies to control feelings of anxiety and low self-efficacy are pivotal for athletes to deliver their best performance under extreme pressure. We consider whether such techniques could improve the preparedness of the newest recruits to the healthcare system, and the impact this could have on patient care. Finally, suggestions for potential research directions within this area are offered to stimulate interest amongst the research community.

A study of Foundation Year doctors’ prescribing in patients with kidney disease at a UK renal unit: a comparison with other prescribers regarding the frequency and type of errors

Objectives Errors in prescribing can cause avoidable harm to patients. Establishing the extent of prescribing errors across medical specialties is critical. This research explores the frequency and types of prescribing errors made by healthcare professionals prescribing for patients with renal disease where prescribing problem-solving and decision-making is complex due to comorbidity. Methods All prescriptions and errors made by prescribers were captured over a 4-month period in a UK renal unit. Data were recorded concerning the medicine associated with the error, the type and severity of the error, and the prescribers occupational grade. Results 10 394 prescribed items were captured and 3.54% had associated prescribing errors. While Foundation Year 1 doctors made almost one error each week (mean 15.13) and Foundation Year 2 doctors one every 2 weeks (mean 8.00), other prescribers made one error per month (mean 3.94). The medicines most frequently associated with errors for Foundation doctors were paracetamol (6.51%), calcium acetate (5.33%), meropenem (3.55%), alfacalcidol (3.55%) and tazocin (3.55%), while for all other prescribers they were meropenem (6.15%), alfacalcidol (4.62%), co-amoxiclav (4.62%) and tacrolimus (4.62%). The most common types of error for both groups were omitting the indication, using the brand name inappropriately, and prescribing inaccurate doses. Conclusions The range of errors made by multi-professional healthcare prescribers confirms the complexity of prescribing on a renal unit for patients with kidney disease and multimorbidity. These findings have implications for the types of educational interventions required for reducing avoidable harm and overcoming human factors challenges to improve prescribing behaviour.

A Qualitative Exploration of the Help-Seeking Behaviors of Students Who Experience Psychological Distress Around Assessment at Medical School

ObjectiveMedical students are at high risk of experiencing psychological distress at medical school and developing mental ill-health during professional practice. Despite efforts by faculty to raise awareness about this risk, many students choose to suffer in silence in the face of psychological distress. The aim of this study was to explore drivers that prompted help-seeking behavior and barriers that prevented individuals prioritizing their well-being around the time of high-stakes assessment at medical school.MethodsSemi-structured interviews were conducted with fifty-seven students who failed high-stakes assessment at two UK medical schools, exploring their experience of academic difficulty and perceptions about causes. A thematic analysis of twenty transcripts that met inclusion criteria was completed to identify key factors that influenced participants’ decisions around seeking help for their psychological distress, and in some cases, mental health problems. Twenty participants who specifically described a deterioration in their mental health around the time of assessment were included in this study.ResultsBarriers to seeking help in these instances included: normalization of symptoms or situation; failure to recognize a problem existed; fear of stigmatisation; overt symptoms of mental distress; and misconceptions about the true nature of the medical school, for example beliefs about a punitive response from the school if they failed. Drivers for seeking help appropriately included: building trust with someone in order to confide in them later on, and self-awareness about the need to maintain good mental health.ConclusionThere are various drivers and barriers for students’ help seeking behaviors when experiencing psychological distress around the time of assessment, particularly self-awareness about the problem and prioritisation of well-being. Students who fail to recognize their own deteriorating mental health are at risk of academic failure and medical schools need to develop strategies to tackle this problem in order to protect these students from harm.

It’s OK for you but maybe not for me: the challenge of putting medical education research findings and evidence into practice

The outputs of medical education research are vast, with published systematic reviews and randomised controlled trials (RCT) through to un-published student projects and conference posters all emerging at a relentless pace. A major challenge for medical educators is how to use all the learning from these outputs to inform their practice. Our personal experience as medical educators, as well as a short scoping literature review, identified little guidance on this essential aspect of medical education. We present some approaches that have been tried in other areas of medicine, especially public health.[1]