Vikram Jha

A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine

Objectives  An essential aspect of medical education is to facilitate the development and assessment of appropriate attitudes towards professionalism in medicine. This systematic review provides a summary of evidence for measures that have been used to assess these attitudes and their psychometric rigour. It also describes interventions that have been found to be effective in changing such attitudes.

Strategies and interventions for the involvement of real patients in medical education: a systematic review

Objectives  There is increasing emphasis on encouraging more active involvement of patients in medical education. This is based on the recognition of patients as ‘experts’ in their own medical conditions and may help to enhance student experiences of real‐world medicine. This systematic review provides a summary of evidence for the role and effectiveness of real patient involvement in medical education.

Perceptions of professionalism in medicine: a qualitative study

Purpose  Current guidelines for medical undergraduate education require students to develop appropriate attitudes towards professionalism. As much of the literature defines professionalism in vague terms − altruism, humanism, excellence − few studies have operationalised medical professionalism. This study aims to describe the views and experiences individuals have about medical professionalism to provide a more comprehensive understanding of medical professionalism.

Patient involvement in teaching and assessing intimate examination skills: a systematic review

Medical Education 2010: 44: 347–357

Evaluating the utility of workplace-based assessment tools for speciality training

Workplace assessment has been incorporated into speciality training in the UK following changes in the training and work patterns within the National Health Service (NHS). There are various types of assessment tools that have been adopted to assess the clinical competence of trainees. In obstetrics and gynaecology, these include mini-CEX, Objective Structured Assessment of Technical skills (OSATS) and case-based discussion (CbDs). This review provides a theoretical background of workplace assessment and the educational framework that may be adopted to evaluate their effectiveness. It summarises current evidence for the utility of these tools with regard to reliability, validity, acceptability, educational impact and cost.

Medical professionalism across cultures: A challenge for medicine and medical education

Abstract Background: The recognition of medical professionalism as a complex social construct makes context, geographical location and culture important considerations in any discussion of professional behaviour. Medical students, medical educators and practitioners are now much more on the move globally, exposing them to cultural and social attitudes, values and beliefs that may differ from their own traditional perceptions of professionalism. Aims and Methods: This paper uses the model of the intercultural development continuum and the concept of “cultural fit” to discuss what might transpire when a student, teacher or doctor is faced with a new cultural environment. Using our own experiences as medical educators working abroad and supported by evidence in the literature, we have developed four anecdotal scenarios to highlight some of the challenges that different cultural contexts bring to our current (Western) understanding of professionalism. Results and Conclusions: The scenarios highlight some of the potentially different regional and/or cultural perspectives and nuances of professional behaviours, attitudes or values that many of us either take for granted or find difficult, depending on our training and socio-cultural upbringing. With this paper, we hope to start a long overdue conversation about global professionalism amongst medical educators, identify potential areas for research and highlight a need for medical schools to embrace a “global” approach to how professionalism is embedded in their curricula.

What educators and students really think about using patients as teachers in medical education: a qualitative study

Objectives  Patients play an integral part in medical education, either as passive, clinical exemplars or as more active facilitators in the development of skills. In theory, the patient‐teacher may enhance the student learning experience by creating an environment similar to that of the medical workplace and encouraging the process of becoming a professional. Although many medical schools have integrated patient‐teachers within their curricula, there is little evidence of how those involved in providing or receiving medical education view patient‐teachers’ contributions to their education. This study investigates the views and experiences of medical tutors and students of involving patients in undergraduate curricula.

Development of transferable skills during short special study modules: students' self-appraisal

Special study modules (SSMs) were introduced into the Leeds undergraduate medical curriculum following recommendations by the General Medical Council (GMC). The main rationale behind such project work is to enable students to develop the skills and attitudes necessary for future self-directed learning along with the knowledge required to practise as competent doctors. At the University of Leeds, the students complete SSM monitoring forms for each SSM in the fourth year, aimed at allowing students to self-evaluate the SSMs. In addition, it provides useful feedback from the students on the themes of the projects as well as on the transferable skills developed by the students during their individual SSMs. The aim of the study was to identify the themes pursued in each project, look at the transferable skills developed and evaluate the differences or similarities between the type of project pursued and the themes and skills identified in the different specialities. A total of 181 monitoring forms of fourth-year students were analysed for the themes and the transferable skills identified. There were 55 students each in Obstetrics and Gynaecology and Paediatrics and 50 students each in Psychiatry and General Practice/Public Health. The results from the four specialities were compared for themes and skills identified. Overall, health and prevention was the commonest theme identified followed by communication skills (64.4% and 62.7% respectively). All transferable skills were well represented in the different specialities with information gathering and learning/organizational skills identified by most students as the major component. The feedback from the students is positive in terms of a wide range of transferable skills developed and most of the themes identified by the GMC are being pursued.

Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training

Background Patient safety training often provides learners with a health professionals perspective rather than the patients. Personal narratives of health-related harm allow patients to share their stories with health professionals to influence clinical behaviour by rousing emotions and improving attitudes to safety. Aim This study measured the impact of patient narratives used to train junior doctors in patient safety. Methods An open, multi-centre, two-arm, parallel design randomised controlled trial was conducted in the North Yorkshire East Coast Foundation School (NYECFS). The intervention consisted of 1-h-long patient narratives followed by discussion. The control arm received conventional faculty-delivered teaching. The Attitude to Patient Safety Questionnaire (APSQ) and the Positive and Negative Affect Schedule (PANAS) were used to measure the impact of the intervention. Results 142 trainees received the intervention; 141 the control teaching. There was no evidence of a difference in post-intervention APSQ scores between the groups. There was a statistically significant difference in the underlying distribution of both post PA (positive affect) and post NA (negative affect) scores between the groups on the PANAS (p<0.001) with indications of both higher PA and NA scores in the intervention group. Conclusions Involving patients with experiences of safety incidents in training has an ideological appeal and seems an obvious choice in designing safety interventions. On the basis of our primary outcome measure, we were unable to demonstrate effectiveness of the intervention in changing general attitudes to safety compared to control. While the intervention may impact on emotional engagement and learning about communication, we remain uncertain whether this will translate into improved behaviours in the clinical context or indeed if there are any negative effects. Trial registration number Grant reference no. RP-PG-0108-10049.

Patient-led training on patient safety:a pilot study to test the feasibility and acceptability of an educational intervention

Background: Training in patient safety is an important element of medical education. Most educational interventions on patient safety training adopt a ‘health-professional lens’ with limited consideration on the impact of safety lapses on the patient and their families and little or no involvement of patients in the design or delivery of the training. Aims: This paper describes a pilot study to test the feasibility and acceptability of implementing a patient-led educational intervention to facilitate safety training amongst newly qualified doctors. Method: Patients and/or carers who had experienced harm during their care shared narratives of their stories with trainees; this was followed by a focused discussion on patient safety issues exploring the causes and consequences of safety incidents and lessons to be learned from these. Results: The intervention, which will be further tested in an NIHR-funded randomised controlled trial (RCT), was successfully implemented into an existing training programme and found acceptance amongst the patients and trainees. Conclusion: The pilot study proved to be a useful step in refining the intervention for the RCT including identifying appropriate outcome measures and highlighting organisational issues.