scholarly journals What are junior doctors for? The work of Foundation doctors in the UK: a mixed methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027522 ◽  
Author(s):  
Gillian Vance ◽  
Sharmila Jandial ◽  
Jon Scott ◽  
Bryan Burford
Keyword(s):  
Mixed Methods ◽  
Medical Training ◽  
Mixed Methods Study ◽  
Junior Doctors ◽  
Cross Sectional ◽  
Postgraduate Medical Training ◽  
Foundation Programme ◽  
Independent Practitioner ◽  
Definition Of ◽  
The Uk

ObjectivesTo examine what activities constitute the work of Foundation doctors and understand the factors that determine how that work is constructed.DesignCross-sectional mixed methods study. Questionnaire survey of the frequency with which activities specified in curricular documents are performed. Semistructured interviews and focus groups.SettingPostgraduate medical training in the UK.ParticipantsDoctors in their first 2 years of postgraduate practice (Foundation Programme). Staff who work with Foundation doctors—supervisors, nurses and employers (clinical; non-clinical).ResultsSurvey data from 3697 Foundation doctors identified curricular activities (41/103, 42%) that are carried out routinely (performed at least once or twice per week by >75% of respondents). However, another 30 activities (29%) were carried out rarely (at least once or twice per week by <25% respondents), largely because they are routinely part of nurses’, and not doctors’, work. Junior doctors indicated their work constituted three roles: ‘support’ of ward and team, ‘independent practitioner’ and ‘learner’. The support function dominated work, but conflicted with stereotyped expectations of what ‘being a doctor’ would be. It was, however, valued by the other staff groups. The learner role was felt to be incidental to practice, but was couched in a limited definition of learning that related to new skills, rather than consolidation and practice. Activities and perceived role were shaped by the organisational context, medical hierarchies and through relationships with nurses, which could change unpredictably and cause tension. Training progression did not affect what activities were done, but supported greater autonomy in how they were carried out.ConclusionsNew doctors must be fit for multiple roles. Strategies for transition should manage graduates’ expectations of real-world work, and encourage teams and organisations to better accommodate graduates. These strategies may help ensure that new doctors can adapt to the variable demands of the evolving multiprofessional workforce.

How are SJT Questions Created?

2018 ◽  
Author(s):  
David Metcalfe ◽  
Harveer Dev
Keyword(s):  
Focus Groups ◽  
Medical Training ◽  
Job Analysis ◽  
Training And Development ◽  
Junior Doctors ◽  
Test Conditions ◽  
Initial Stage ◽  
Foundation Programme ◽  
Professional Attributes ◽  
The Uk

The SJT questions were created following the professional attributes identified from the FY1 job analysis. Questions were written by volunteers at a series of dedicated workshops. The volunteers were not all doctors but should have been familiar with the FY1 role and have worked with junior doctors within the previous two years. The ISFP Project Group employed 89 people to write SJT questions, of whom 69 (77.5%) were senior doctors, two (2.2%) were lay representatives, and the remainder were undeclared. In terms of background, 59 (66.3%) were from a range of acute specialties and 12 (13.5%) from community specialties. This team created a bank of 453 possible questions. These were scrutinized by a team of psychologists who accepted 360 questions as passing this initial stage. A select few writers were asked to moderate all questions to ensure that scenarios were realistic and the terminology was in use across the UK. This group eliminated additional questions, leaving a total of 306. A series of focus groups was then held with foundation doctors who scrutinized the test instructions and up to 20 questions each. They proposed a number of amendments and whittled down the total question bank to 275 items. Once a question bank was established, it was trialled using a panel of subject ‘experts’, i.e. people with similar qualifications to the question writers. Questions survived this process if they achieved a satisfactory level of concordance, i.e. enough experts independently arrived at the same answer under test conditions. A total of 200 questions went forward to be used in the SJT pilots. The SJT model underwent two pilots. The second and larger of these took place in 13 UK medical schools, involving 639 final- year students. Students reported that the content seemed relevant to the Foundation Programme (85% agreed) and that the questions were fair (73.3%). The reasons for understanding how questions are created are to appreciate the following: ● A lot of thought has gone into every question. There should be no ambiguities (unless intended) or ‘tricks’. ● They are written (largely) by senior doctors who are presumably interested in medical training and development.

scholarly journals The association between mentoring and training outcomes in junior doctors in medicine: an observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020721 ◽  
Author(s):  
John Ong ◽  
Carla Swift ◽  
Nicholas Magill ◽  
Sharon Ong ◽  
Anne Day ◽  
...  
Keyword(s):  
Observational Study ◽  
Medical Training ◽  
Positive Association ◽  
Career Progression ◽  
Junior Doctors ◽  
Pass Rates ◽  
Training Outcomes ◽  
Postgraduate Medical Training ◽  
Significant Events ◽  
The Uk

ObjectiveTo determine quantitatively if a positive association exists between the mentoring of junior doctors and better training outcomes in postgraduate medical training within the UK.DesignObservational study.Participants117 trainees from the East of England Deanery (non-mentored group) and the recently established Royal College of Physicians (RCP) Mentoring scheme (mentored group) who were core medical trainees (CMTs) between 2015 and 2017 completed an online survey. Trainees who received mentoring at the start of higher specialty training, incomplete responses and trainees who were a part of both the East of England deanery and RCP Mentoring scheme were excluded leaving 85 trainees in the non-mentored arm and 25 trainees in the mentored arm. Responses from a total of 110 trainees were analysed.Main outcome measuresPass rates of the various components of the Membership of the Royal College of Physicians (MRCP) (UK) examination (MRCP Part 1, MRCP Part 2 Written and MRCP Part 2 PACES), pass rates at the Annual Review of Competency Progression (ARCP), trainee involvement in significant events, clinical incidents or complaints and trainee feedback on career progression and confidence.ResultsMentored trainees reported higher pass rates of the MRCP Part 1 exam versus non-mentored trainees (84.0% vs 42.4%, p<0.01). Mentored international medical graduates (IMGs) reported higher pass rates than non-mentored IMGs in the MRCP Part 2 Written exam (71.4% vs 24.0%, p<0.05). ARCP pass rates in mentored trainees were observed to be higher than non-mentored trainees (95.8% vs 69.9%, p<0.05). Rates of involvement in significant events, clinical incidents and complaints in both groups did not show any statistical difference. Mentored trainees reported higher confidence and career progression.ConclusionsA positive association is observed between the mentoring of CMTs and better training outcomes. Further studies are needed to investigate the causative effects of mentoring in postgraduate medical training within the UK.

scholarly journals Evaluating the validity of the selection measures used for the UK’s foundation medical training programme: a national cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e021918 ◽  
Author(s):  
Daniel T Smith ◽  
Paul A Tiffin
Keyword(s):  
Medical Training ◽  
Training Programme ◽  
Performance Measure ◽  
Successful Completion ◽  
Educational Achievements ◽  
Postgraduate Medical Training ◽  
Situational Judgement Test ◽  
Foundation Programme ◽  
Selection Measures ◽  
The Uk

ObjectivesCurrently relative performance at medical school (educational performance measure (EPM) decile), additional educational achievements and the score on a situational judgement test (SJT) are used to rank applicants to the UK Foundation Years postgraduate medical training programme. We sought to evaluate whether these three measures were predictive of subsequent successful completion of the programme, and thus were valid selection criteria.MethodsData were obtained from the UK Medical Education Database (UKMED) on 14 131 UK applicants to the foundation programme starting in 2013 and 2014. These data included training outcomes in the form of Annual Reviews of Competency Progression (ARCPs), which indicated whether the programme was successfully completed. The relationship between applicants’ performance on the three selection measures to the odds of successful programme completion were modelled.ResultsOn univariable analyses, all three measures were associated with the odds of successful completion of the programme. Converting the SJT score to deciles to compare the effect sizes suggested that one decile increase in the EPM increased the odds of completing the programme by approximately 15%, whereas the equivalent value was 8% for the SJT scores. On multivariable analyses (with all three measures included in the model), these effects were only independently and statistically significant for EPM decile (OR 1.14, 95% CI 1.10 to 1.18, p<0.001) and SJT z-score decile (OR 1.05, 95% CI 1.01 to 1.09, p=0.02).ConclusionsThe EPM decile and SJT scores may be effective selection measures for the foundation programme. However, educational achievements does not add value to the other two measures when predicting programme completion. Thus, its usefulness in this context is less clear. Moreover, our findings suggest that the weighting for the EPM decile score, relative to SJT performance, should be increased.

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

scholarly journals Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christophe Millien ◽  
Anatole Manzi ◽  
Arlene M. Katz ◽  
Hannah Gilbert ◽  
Mary C. Smith Fawzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Methods ◽  
Black Women ◽  
Uterine Fibroids ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Cross Sectional ◽  
Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

Factors relating to working hours restriction that have impacted the professional identity of trainees in the last decade

2021 ◽  
Vol 82 (3) ◽  
pp. 1-10
Author(s):  
Soumya Mukherjee ◽  
James Meacock ◽  
Eleanor Kissane ◽  
Debasish Pal
Keyword(s):  
Identity Development ◽  
Professional Identity ◽  
Medical Training ◽  
Working Hours ◽  
Junior Doctors ◽  
Clinical Experiences ◽  
Postgraduate Medical Training ◽  
European Working ◽  
Working Time Directive ◽  
The Impact

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or ‘being a doctor’. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

scholarly journals Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors

2018 ◽  
Vol 188 (2) ◽  
pp. 633-639 ◽  
Author(s):  
Hannah Linane ◽  
Fergal Connolly ◽  
Lyle McVicker ◽  
Sharon Beatty ◽  
Orla Mongan ◽  
...  
Keyword(s):  
Mixed Methods ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychological Impact ◽  
Mixed Methods Study ◽  
Junior Doctors ◽  
Life Care

scholarly journals Consent for the use of human biological samples for biomedical research: a mixed methods study exploring the UK public's preferences

BMJ Open ◽  
2013 ◽  
Vol 3 (8) ◽  
pp. e003022 ◽  
Author(s):  
Celine Lewis ◽  
Margaret Clotworthy ◽  
Shona Hilton ◽  
Caroline Magee ◽  
Mark J Robertson ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Biomedical Research ◽  
Biological Samples ◽  
Mixed Methods Study ◽  
The Uk

scholarly journals Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101008 ◽  
Author(s):  
Umar Chaudhry ◽  
Judith Ibison ◽  
Tess Harris ◽  
Imran Rafi ◽  
Miles Johnston ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Clinical Information ◽  
Mixed Methods Study ◽  
Strong Positive Correlation ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Positive Experiences ◽  
Positive Correlations ◽  
Observation Tools

BackgroundPrimary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees’ preparation for, or experiences and perceptions of, them.AimTo understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations.Design & settingA mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees.MethodA cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis.ResultsThe survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations.ConclusionThis project sheds light on GP trainees’ current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

scholarly journals The validity of the Annual Review of Competence Progression: a qualitative interview study of the perceptions of junior doctors and their trainers

2017 ◽  
Vol 110 (3) ◽  
pp. 110-117 ◽  
Author(s):  
Rowena Viney ◽  
Antonia Rich ◽  
Sarah Needleman ◽  
Ann Griffin ◽  
Katherine Woolf
Keyword(s):  
Assessment Tool ◽  
Medical Training ◽  
Annual Review ◽  
Junior Doctors ◽  
Postgraduate Medical Training ◽  
Medical Graduates ◽  
Qualitative Interview Study ◽  
Negative Perceptions ◽  
Positive Experiences ◽  
Graduate Trainees

Objective To investigate trainee doctors’ and trainers’ perceptions of the validity of the Annual Review of Competence Progression (ARCP) using Messick’s conceptualisation of construct validity. Design Qualitative semi-structured focus groups and interviews with trainees and trainers. Setting Postgraduate medical training in London, Kent Surrey and Sussex, Yorkshire and Humber, and Wales in November/December 2015. Part of a larger study about the fairness of postgraduate medical training. Participants Ninety-six trainees and 41 trainers, comprising UK and international medical graduates from Foundation, General Practice, Medicine, Obstetrics and Gynaecology, Psychiatry, Radiology, and Surgery, at all levels of training. Main outcome measures Trainee and trainer perceptions of the validity of the ARCP as an assessment tool. Results Participants recognised the need for assessment, but were generally dissatisfied with ARCPs, especially UK graduate trainees. Participants criticised the perceived tick-box nature of ARCPs as measuring clerical rather than clinical ability, and which they found detrimental to learning. Trainees described being able to populate their e-portfolios with just positive feedback; they also experienced difficulty getting assessments signed off by supervisors. ARCPs were perceived as poor at identifying struggling trainees and/or as discouraging excellence by focussing on minimal competency. Positive experiences of ARCPs arose when trainees could discuss their progress with interested supervisors. Conclusions Trainee and trainer criticisms of ARCPs can be conceptualised as evidence that ARCPs lack validity as an assessment tool. Ongoing reforms to workplace-based assessments could address negative perceptions of the ‘tick-box’ elements, encourage constructive input from seniors and allow trainees to demonstrate excellence as well as minimal competency, while keeping patients safe.

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