Sam Regan de Bere

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

Medical Education 2010: 44: 449–458

From anatomical ‘competence’ to complex capability. The views and experiences of UK tutors on how we should teach anatomy to medical students

Developments in clinical education have recently challenged the identity of anatomy teaching and learning, leading to high profile debate over the potential implications for the competence levels of new doctors. However, the emphasis remains on methods of teaching, rather than a review of what well-rounded anatomical learning actually entails, and how teaching can address contemporary learning needs. This paper identifies and addresses some of these issues, drawing on expert views captured in qualitative research with anatomy tutors at twenty different medical schools in the UK. Three main themes emerging from our analysis are described: anatomy as a subject matter, the challenges of teaching or learning anatomy, and the use of teaching methods. We also detail how inductive analysis generated new hypotheses worthy of further consideration. These fall into two key categories: (1) improving anatomy curriculum design and (2) advancing anatomy education research.

How we teach anatomy without cadavers

Peninsula Medical School, one of four new medical schools to open in the UK in 2002–2003, has taken this radical step. So, what was behind our thinking? We asked ourselves how doctors encounter anatomy in clinical practice. The answer is through living and surface anatomy on the one hand, and through medical imaging on the other. It therefore seemed to make more sense to teach anatomy to students in this context, right from the beginning. The whole principle of the medical school is based upon giving students authentic experiences from the start of the course. For instance, students meet their first patients in community settings in their first two weeks. They engage in clinical skills training, from the start, continuing throughout the course. Problem based learning is used to introduce them to team working and clinical reasoning. In teaching anatomy, we decided that we would rely upon living anatomy delivered to the students through the use of peer examination and life models, and on medical imaging.

the United Kingdom's Experience With and Future Plans for Revalidation

&NA; Assuring fitness to practice for doctors internationally is increasingly complex. In the United Kingdom, the General Medical Council (GMC) has recently launched revalidation, which has been designed to bring all doctors into a governed environment. Since December 2012, all doctors who wish to practice are required to submit and reflect on supporting documentation against a framework of best practice, Good Medical Practice. These documents are brought together in an annual appraisal. Evidence of practice includes clinical governance activities such as significant events, complaints and audits, continuing professional development and feedback from colleagues and patients. Revalidation has been designed to support professionalism and identify early doctors in difficulty to support their remediation and so assure patient safety. The appraiser decides annually if the doctor has met the standard which is shared with the most senior doctor in the area, the responsible officer (RO). The ROs role is to make a recommendation for revalidation every 5 years for each doctor to the GMC. Revalidation is unique in that it is national, compulsory, involves all doctors regardless of position or training, and is linked to the potentially performance moderating process of appraisal. However, it has a long and troubled history that is shaped by high‐profile medical scandals and delays from the profession, the GMC, and the government. Revalidation has been complicated further by rhetoric around patient care and driving up standards but at the same time identifying poor performance. The GMC have responded by commissioning a national evaluation which is currently under development.

Students’ views on the impact of peer physical examination and palpation as a pedagogic tool for teaching and learning living human anatomy

Background: Modern medical education teaching and learning approaches now lay emphasis on students acquiring knowledge, skills and attitudes relevant to medical practice. Aims: To explore students’ perceived impacts of using hands-on approaches involving peer/life model physical examination and palpation in teaching and learning living human anatomy on their practice of physical examination of real patients. Methods: This study used exploratory focus groups and a questionnaire survey of years 3–5 medical students. Results: The focus group discussions revealed new insights into the positive impacts of the hands-on approaches on students’ clinical skills and professional attitudes when dealing with patients. Students’ exposure to the hands-on approaches helped them to feel comfortable with therapeutically touching unclothed patients’ bodies and physically examining them in the clinical environment. At least 60% of the questionnaire survey respondents agreed with the focus group participants on this view. Over 75% also agreed that the hands-on experiences helped them develop good professional attitudes in their encounter with patients. Conclusions: This study highlights the perceived educational value of the hands-on approaches as a pedagogic tool with a positive impact on students’ clinical skills and professional attitudes that helps in easing their transition into clinical practice.

Towards a pedagogy for patient and public involvement in medical education

This paper presents a critique of current knowledge on the engagement of patients and the public, referred to here as patient and public involvement (PPI), and calls for the development of robust and theoretically informed strategies across the continuum of medical education.

No one has yet properly articulated what we are trying to achieve: a discourse analysis of interviews with revalidation policy leaders in the United Kingdom.

Purpose To analyze prevailing definitions of revalidation (i.e., a recently instituted system of ongoing review for all physicians in the United Kingdom), the circumstances of their origin, and proposed applications, after a protracted and sometimes difficult decade in development. This was to support a more consensual approach to revalidation policy before its launch in 2012. Method In 2010 and 2011, the authors carried out a critical discourse analysis of interviews with 31 medical and legal revalidation policy makers. These individuals represented the main stakeholder bodies, including the General Medical Council, Academy of Medical Royal Colleges, British Medical Association, National Health Service Employers, and the departments of health from across the United Kingdom. Results The authors identified two overarching discourses: regulation and professionalism, held together by patients as “discursive glue.” Regulation frames revalidation as a way to identify “bad apples,” requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model. Conclusions These two discourses were not mutually exclusive; indeed, most interviewees used them interchangeably. However, they are in some regards at odds. Their coexistence has been supported by a shared discursive formation around patients. Yet the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process.

Achieving health improvements through interprofessional learning in south west England

The NHS Executive South West, part of the Department of Health for England, has developed a programme of action to demonstrate that health improvements can be achieved through interprofessional learning. The NHS Executive South West has funded three projects to develop and evaluate interprofessional learning opportunities for health care practitioners at postgraduate and undergraduate levels. The paper describes the origins, progress and early learning from the project sites. The project sites are addressing improvement issues by the application of continuous quality improvement to elderly care, mental health, child and family care, severe and enduring mental heath problems, and the lived experience of people with cancer.

Availability of a virtual learning environment does not compensate for the lack of a physical facility.

A virtual learning environment (VLE), including access to on-line journals, was set up in support of a new medical curriculum delivered at two campuses. We evaluated student perceptions and use of the VLE including the library facilities using several qualitative and quantitative data methods and the results were triangulated. Paper copies of set texts are provided at each site; however, one site also has a traditional library for the training of professions allied to medicine. As the teaching was identical at each site, this gave us the opportunity for a study exploring the effect of having a physical library facility on the use of the VLE. Although ten-fold more loans were made from the library with the medical sources than from the other site, use of the VLE was very similar at both sites, suggesting that reduced access to hard copy books and journals was not compensated for by increased use of electronic library resources. As expected, training, ease of navigation and access to the VLE were very important to student satisfaction.

The impact of large scale licensing examinations in highly developed countries: a systematic review

BackgroundTo investigate the existing evidence base for the validity of large-scale licensing examinations including their impact.MethodsSystematic review against a validity framework exploring: Embase (Ovid Medline); Medline (EBSCO); PubMed; Wiley Online; ScienceDirect; and PsychINFO from 2005 to April 2015. All papers were included when they discussed national or large regional (State level) examinations for clinical professionals, linked to examinations in early careers or near the point of graduation, and where success was required to subsequently be able to practice. Using a standardized data extraction form, two independent reviewers extracted study characteristics, with the rest of the team resolving any disagreement. A validity framework was used as developed by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education to evaluate each paper’s evidence to support or refute the validity of national licensing examinations.Results24 published articles provided evidence of validity across the five domains of the validity framework. Most papers (n = 22) provided evidence of national licensing examinations relationships to other variables and their consequential validity. Overall there was evidence that those who do well on earlier or on subsequent examinations also do well on national testing. There is a correlation between NLE performance and some patient outcomes and rates of complaints, but no causal evidence has been established.ConclusionsThe debate around licensure examinations is strong on opinion but weak on validity evidence. This is especially true of the wider claims that licensure examinations improve patient safety and practitioner competence.