Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification

Crafting British medicine in the Empire: the establishment of medical schools in India and Canada, 1763-1837

In the early nineteenth century, medical schools became a growing means of regulating medicine in the British Empire, both in the metropole and in two colonies: India and Canada. By examining the establishment of medical schools in Calcutta, Bombay, Madras, Quebec City, Montreal and Toronto between the end of the Seven Years' War and the beginning of the Victorian era, this article argues that the rise of the British Empire was a key factor in the gradual replacement of private medical apprenticeships with institutional medical education. Although the imperial state did not implement a uniform medical policy across the British Empire, the medical schools established under its jurisdiction were instrumental in devising a curriculum that emphasised human dissection, bedside training in hospitals and organic chemistry as criteria of medical competence.

Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018-2020

BACKGROUND

Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with performance in selection for entry into specialty training in Intensive Care in the United Kingdom.

METHODS

We evaluated data of 509 candidates from the national recruitment rounds of 2018/19 and 2019/20. The outcome evaluated was "success at interview". Variables reaching statistical significance at univariate logistic regression analysis were fed in the multivariable analysis to identify independent predictors of success, with additional exploratory analyses performed, where indicated.

RESULTS

The candidates' median age was 31.5 (interquartile range, IQR 30-33.7) years, 324 (63.7%) were male, 256 (50.3%) not married/in civil partnership, 6 (1.2%) pregnant. The majority (316, 62.1%) were White British, 99 (19.5%) of Asian background, other ethnicities represented less than 20% of the sample. Of the 509 candidates, 155 (30.5%) were Atheist, 140 (27.5%) Christian; most were heterosexual (440, 86.4%); 432 (84.9%) reported no disability, while 4 (0.8%) had a minor and 1 (0.2%) had a major disability; 432 (84.9%) candidates held a UK medical degree; 77 (15.1%) a non-UK degree. At univariate logistic regression analysis (LRA) multiple factors were found to be associated with a lower likelihood of success, the strongest being an international medical graduate (IMG, holding a non-UK medical degree); others were increasing age, male gender, being married, Asian or mixed ethnicity, specific religious beliefs (Buddhism, Islam and Hinduism). After feeding all factors significant at univariate analysis, the only two retained as independent predictors at multivariable regression were Asian ethnicity and holding a non-UK degree. Asian UK graduates success rate was 92.7%, comparable to the national average of 92.3%, the Asian IMGs success rate was significantly lower, at 45.5%.

CONCLUSIONS

As the imbalances seen within the candidates of Asian background are explained by considering the country of primary medical training, the variations in performance is likely to reflect differences in training systems and understanding of the UK NHS.

Recent research into healthcare professions regulation: a rapid evidence assessment

BACKGROUND AND AIMS

Over the last decade, regulators have taken significant steps towards tackling perceptions that regulatory systems are burdensome. There has been much international research activity in the regulation of health and care professionals. This article reports a review of studies on health professions regulation between January 2011 and March 2020. Its chief object was to provide robust and up-to-date evidence to assist regulators in policy development and implementation. The main objectives of this study were to: 1. Identify and retrieve research in the field of health and care professions regulation in English since 2011; 2. Evaluate the published research, exploring its utility to regulators and practitioners, and drawing out any key messages; 3. Draw conclusions concerning the scope and limitations of the research literature and identify areas for further research.

METHODS

We undertook a rapid evidence assessment (REA) of the international literature on health and care professions regulation, including reviewing ten UK regulators' websites to identify issues of concern and strategic priorities. We retrieved 3833 references, using a four-stage screening process to select the 81 most relevant.

RESULTS

Results are reported within six key themes: harm prevention and patient safety; fitness to practise; quality assurance of education and training; registration including maintenance of registers; guidelines and standards and relations with regulatory bodies.

CONCLUSIONS

Regulation of professionals in health and care is comparatively undeveloped as a field of academic study. Consequently, the published evidence is diffuse and small-scale. Most work presents relatively weak data of low relevance to regulators, mainly reporting or describing the current position. Few studies are able to show the impact of regulation or demonstrate a causal link between regulation and its effects. To inform their research and policy agendas health and social care regulators need to commission, interpret and apply the scholarly literature more effectively; academics need to engage with regulators to ensure that their research provides high-quality evidence with practical relevance to the regulators' agendas. Further study is needed to explore how effective academic collaborations between regulators and researchers may be created and sustained.

A theory-based study of doctors' intentions to engage in professional behaviours

BACKGROUND

The Theory of Planned Behaviour (TPB) has been proposed as an appropriate model for creating a theory-driven approach to teaching medical professionalism. However, there is a lack of empirical evidence into its efficacy. This study explores if the TPB can assess UK medical doctors' professional behaviours and explores if there are differences in the TPB's efficacy depending on doctors' primary medical qualification (UK or outside).

METHODS

Three hundred fourteen doctors in England at 21 NHS Trusts completed a questionnaire about reflective practice, using the General Medical Council's confidentiality guidance, and raising a patient safety concern. The majority of participants were male (52%), white (68%), consultants (62%), and UK medical graduates (UKGs) (71%).

RESULTS

The TPB variables of attitudes, subjective norms, and perceived behavioural control were predictive of intention to engage in raising concerns (R² = 35%), reflection (R² = 52%), and use of confidentiality guidance (R² = 45%). Perceived behavioural control was the strongest predictor of intentions to raise a concern (β = 0.44), while attitude was the strongest predictor of intentions to engage in reflective practice (β = 0.61) and using confidentiality guidance (β = 0.38). The TBP constructs predicted intention for raising concerns and reflecting for both UKGs and non-UKGs (Fs ≥ 2.3; ps ≤ .023, βs ≥ 0.12). However, only perceived behaviour control was predictive of intentions to use guidance for both UKGs and non-UKGs (β = 0.24) while attitudes and norms were just predictive for UKGs (βs ≥ 0.26).

CONCLUSIONS

This study demonstrates the efficacy of the TPB for three professional behaviours. The implications for medical educators are to use the variables of the TPB (attitudes, subjective norms, and perceived behavioural control) in the education of professionalism, and for medical education researchers to further our understanding by employing the TPB in more empirical studies of non-clinical behaviours.

Are there differences between those doctors who apply for a training post in Foundation Year 2 and those who take time out of the training pathway? A UK multicohort study

INTRODUCTION

Knowledge about the career decisions of doctors in relation to specialty (residency) training is essential in terms of UK workforce planning. However, little is known about which doctors elect to progress directly from Foundation Year 2 (F2) into core/specialty/general practice training and those who instead opt for an alternative next career step.

OBJECTIVE

To identify if there were any individual differences between these two groups of doctors.

DESIGN

This was a longitudinal, cohort study of 'home' students who graduated from UK medical schools between 2010 and 2015 and completed the Foundation Programme (FP) between 2012 and 2017.We used the UK Medical Education Database (UKMED) to access linked data from different sources, including medical school performance, specialty training applications and career preferences. Multivariable regression analyses were used to predict the odds of taking time out of training based on various sociodemographic factors.

RESULTS

18 380/38 905 (47.2%) of F2 doctors applied for, and accepted, a training post offer immediately after completing F2. The most common pattern for doctors taking time out of the training pathway after FP was to have a 1-year (7155: 38.8%) or a 2-year break (2605: 14.0%) from training. The odds of not proceeding directly into core or specialty training were higher for those who were male, white, entered medical school as (high) school leavers and whose parents were educated to degree level. Doctors from areas of low participation in higher education were significantly (0.001) more likely to proceed directly into core or specialty training.

CONCLUSION

The results show that UK doctors from higher socioeconomic groups are less likely to choose to progress directly from the FP into specialty training. The data suggest that widening access and encouraging more socioeconomic diversity in our medical students may be helpful in terms of attracting F2s into core/specialty training posts.

Doctors on the move: a qualitative study on the driving factors in a group of Egyptian physicians migrating to Germany

Background

Migration of physicians has become a global phenomenon with significant implications for the healthcare delivery systems worldwide. The motivations and factors driving physician’s migration are complex and continuously evolving. Purpose of this study is to explore the driving forces in a group of Egyptian physicians and final-years medical students preparing to migrate to Germany.

Methods

A qualitative study was conducted based on social constructivism epistemology. In five focus group discussions, there participated a total 12 residents and 6 final-year medical students from 7 different training and workplace locations in Egypt. The participants provided information about their motivation and planning for migration. We applied a coding framework based on the concept of push/pull factors and barriers/facilitators for migration, and used Atlas.ti software for analysis.

Results

The thematic analysis indicated that the migration within the study’s participants results from a specific weighting of push and pull factors. Push factors are considered to be more important than pull factors. Factors related to professional development play a leading role. The route of migration towards Germany is mainly determined by the low hurdle registration and licensing requirements in this destination country compared to other countries. In some cases, Germany is regarded as a “transit country”, a step on the road to other European countries. The intent, planning and preparation of migration is assisted considerably by the local formation of a community and culture of migration with multiple ways for information exchange, identity building and social support through face-to-face and online channels.

Conclusions

This study specifies – in a group of Egyptian physicians and final-year medical students – the perceived push and pull factors which influenced their intent to migrate to Germany. In addition to the general wealth gap, their particular route of migration is mainly determined by the requirements in licensing and registration procedures for foreign physicians in the potential destination country. The planning and preparation of a move is substantially facilitated by their joining a social network and a community of migrating physicians.

Country of qualification is linked to doctors' General Medical Council performance assessment rate, but is it linked to their clinical competence?

Mehdizah and colleagues recently described the prevalence of General Medical Council regulatory performance assessments by doctors' country of primary medical qualification. This article has caused anger within the UK-international medical community because it identifies graduates of certain countries with significantly raised prevalence.The present article comments on evidence from published Royal College of General Practitioners' data that support these conclusions. However, in an increasingly international age of medical education, the ambiguity of attributions of qualifying from a certain country needs addressing. Some medical students of British nationality, for example, who fail to obtain a place at a UK medical school, train in medical schools abroad, and thus may be identified as international medical graduates.Please see related article: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0903-6 .