Simon Watmough

Pre-registration house officers' views on studying under a reformed medical curriculum in the UK

Context  In 1996 the University of Liverpool introduced a new curriculum based on the recommendations published in Tomorrows Doctors. This work examines how graduates of that course view their undergraduate curriculum and whether they consider it prepared them well for the pre‐registration year.

Using questionnaires to determine whether medical graduates' career choice is determined by undergraduate or postgraduate experiences.

Background: There has been increased interest in the factors influencing the career choice of doctors. Feminization of the medical workforce, changing health care needs, reform of training has ensured that this is an important issue for workforce planners and educationists. Aims and Methods: Questionnaires were distributed to graduates from the University of Liverpool 5 years post graduation requesting the most important influences on career choice. Results and Conclusions: The majority of graduates felt their career choice was primarily dictated by their postgraduate experience. Graduates chose their career pathway for a number of reasons including specialties that would secure home-work balance, disenchantment with training programmes, and work experiences post graduation rather than their undergraduate clinical attachments.

An evaluation of the performance in the UK Royal College of Anaesthetists primary examination by UK medical school and gender

BackgroundThere has been comparatively little consideration of the impact that the changes to undergraduate curricula might have on postgraduate academic performance. This study compares the performance of graduates by UK medical school and gender in the Multiple Choice Question (MCQ) section of the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination.MethodsData from each sitting of the MCQ section of the primary FRCA examination from June 1999 to May 2008 were analysed for performance by medical school and gender.ResultsThere were 4983 attempts at the MCQ part of the examination by 3303 graduates from the 19 United Kingdom medical schools. Using the standardised overall mark minus the pass mark graduates from five medical schools performed significantly better than the mean for the group and five schools performed significantly worse than the mean for the group. Males performed significantly better than females in all aspects of the MCQ – physiology, mean difference = 3.0% (95% CI 2.3, 3.7), p < 0.001; pharmacology, mean difference = 1.7% (95% CI 1.0, 2.3), p < 0.001; physics with clinical measurement, mean difference = 3.5% (95% CI 2.8, 4.1), p < 0.001; overall mark, mean difference = 2.7% (95% CI 2.1, 3.3), p < 0.001; and standardised overall mark minus the pass mark, mean difference = 2.5% (95% CI 1.9, 3.1), p < 0.001. Graduates from three medical schools that have undergone the change from Traditional to Problem Based Learning curricula did not show any change in performance in any aspects of the MCQ pre and post curriculum change.ConclusionGraduates from each of the medical schools in the UK do show differences in performance in the MCQ section of the primary FRCA, but significant curriculum change does not lead to deterioration in post graduate examination performance. Whilst females now outnumber males taking the MCQ, they are not performing as well as the males.

Hygiene factors: Using VLE minimum standards to avoid student dissatisfaction

Inconsistency in the use of Virtual Learning Environments (VLEs) has led to dissatisfaction amongst students and is an issue across the Higher Education sector. This paper outlines research undertaken in one faculty within one university to ascertain staff and student views on minimum standards within the VLE; how the VLE could reduce student dissatisfaction; and to propose a conceptual framework surrounding student satisfaction with the VLE. A questionnaire was sent to staff and students asking if they agreed with the need to introduce minimum standards in the VLE and what criteria they wanted. The National Student Survey (NSS) results were analysed for six schools within the faculty over a 4-year period. Many of the NSS results were relevant to developing minimum standards with the VLE. The questionnaire results showed the vast majority of staff and students favour the introduction of minimum standards and identified specific items that should be included, for example handbooks, contact information for staff, access to previous modules, assessment information, further reading, etc. The NSS data showed that students wanted lectures available in the VLE, improved feedback, more computers for students and information about cancelled sessions/timetable changes in the VLE. The results suggest the presence of many minimum standards may reduce student dissatisfaction with the VLE. However, a distinction is made between those pre-potent factors that cause dissatisfaction and those that lead to satisfaction, using Herzberg’s Two-Factor Theory as a theoretical basis. When considering minimum standards as ‘hygiene factors’, their presence can prevent student dissatisfaction and provide the foundations for innovation in technology-enhanced learning.

Formalized prescribing error feedback from hospital pharmacists: doctors' attitudes and opinions

Doctors have reported a lack of awareness of their prescribing errors with lack of feedback considered a system failure. This article summarizes the views of hospital doctors about receiving formal prescribing error feedback from ward-based pharmacists.

An evaluation of the impact of country of primary medical qualification on performance in the UK Royal College of Anaesthetists' examinations

Background: Many junior doctors from around the world come to the UK to train and attend professional examinations. Aim: This study summarises the performance of graduates by country of primary medical qualification in part one of the UK Royal College of Anaesthetists (RCA) examination from 1999 to 2008. Methods: Data were collated from RCA spreadsheets for each attempt of the primary examination from June 1999 to May 2008 from the main RCA trainee database. Candidates were ranked into groups according to the country of primary medical qualification for the overall final percentage mark of the multiple choice question section of the Primary Fellowship of the Royal College of Anaesthetists examination. Results: Candidates from Australia, New Zealand, South Africa, Zimbabwe and the UK performed significantly better than the mean for the group and candidates from Egypt, Iraq, Ireland and Pakistan performed significantly worse. Conclusion: Some graduates who sit UK postgraduate exams may require additional support prior to taking these examinations.

Exploring the impact of pharmacist-led feedback on prescribing behaviour: A qualitative study

Background Prescribing errors occur frequently in hospital settings. Interventions to influence prescribing behaviour are needed with feedback one potential intervention to improve prescribing practice. Doctors have reported a lack of feedback on their prescribing previously whilst the literature exploring the impact of feedback on prescribing behaviour is limited. Objectives To explore the impact of pharmacist‐led feedback on prescribing behaviour. Methods Semi‐structured interviews were conducted with doctors who had received prescribing error feedback. A topic guide was used to explore the type of error and what impact feedback was having on prescribing behaviour. All interviews were transcribed verbatim and analysed thematically using a framework approach. Results Twenty‐three prescribers were interviewed and 65 errors discussed over 38 interviews. Key themes included; affective behaviour, learning outcome, prescribing behaviour and likelihood of error recurrence. Feedback was educational whilst a range of adaptive prescribing behaviours were also reported. Prescribers were more mindful and engaged with the prescribing process whilst feedback facilitated reflection, increased self‐awareness and informed self‐regulation. Greater information and feedback‐seeking behaviours were reported whilst prescribers also reported greater situational awareness, and that they were making fewer prescribing errors following feedback. Conclusions Pharmacist‐led feedback was perceived to positively influence prescribing behaviour. Reported changes in prescriber behaviour resonate with the non‐technical skills (NTS) of prescribing with prescribers adapting their prescribing behaviour depending on the environment and prescribing conditions. A model of prescribing is proposed with NTS activated in response to error provoking conditions. These findings have implications for prescribing education to make it a more contextualised educational process.

How competent do graduates feel to undertake the skills required by the General Medical Council

The General Medical Council outlines the skills medical students are meant to learn as undergraduates. This article summarizes how competent some foundation year one doctors from one deanery felt to undertake these skills, what had prepared them and what they would like more training on.

Exploring pharmacist experiences of delivering individualised prescribing error feedback in an acute hospital setting

Highlights:Delivery of prescribing error feedback is valued by hospital pharmacists and considered sustainable.Pharmacists report altered prescribing behaviour and improved prescribing following receipt of feedback.Pharmacists report greater team‐work and prescriber communication following delivery of feedback.Delivering prescribing error feedback can improve the self‐confidence and self‐worth of pharmacists.