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Ekezie W, Martin CA, Baggaley RF, Teece L, Nazareth J, Pan D, Sze S, Bryant L, Woolf K, Gray LJ, Khunti K, Pareek M. Association between ethnicity and migration status with the prevalence of single and multiple long-term conditions in UK healthcare workers. BMC Med 2023; 21:433. [PMID: 38031115 PMCID: PMC10688453 DOI: 10.1186/s12916-023-03109-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Healthcare workers' (HCW) well-being has a direct effect on patient care. However, little is known about the prevalence and patterns of long-term medical conditions in HCWs, especially those from ethnic minorities. This study evaluated the burden of multiple long-term conditions (MLTCs), i.e. the presence of two or more single long-term conditions (LTCs), among HCWs in the United Kingdom (UK) and variation by ethnicity and migration status. METHODS We used baseline data from the UK-REACH cohort study collected December 2020-March 2021. We used multivariable logistic regression, adjusting for demographic, occupational and lifestyle factors to examine the relationship between self-reported LTCs/MLTCs and ethnicity, migration status and time since migration to the UK. RESULTS Of 12,100 included HCWs, with a median age of 45 years (IQR: 34-54), 27% were overseas-born, and 30% were from non-White ethnic groups (19% Asian, 4% Black, 4% Mixed, 2% Other). The most common self-reported LTCs were anxiety (14.9%), asthma (12.2%), depression (10.7%), hypertension (8.7%) and diabetes (4.0%). Mental health conditions were more prevalent among UK-born than overseas-born HCWs for all ethnic groups (adjusted odds ratio (aOR) using White UK-born as the reference group each time: White overseas-born 0.77, 95%CI 0.66-0.95 for anxiety). Diabetes and hypertension were more common among Asian (e.g. Asian overseas, diabetes aOR 2.97, 95%CI 2.30-3.83) and Black (e.g. Black UK-born, hypertension aOR 1.77, 95%CI 1.05-2.99) groups than White UK-born. After adjustment for age, sex and deprivation, the odds of reporting MLTCs were lower in most ethnic minority groups and lowest for those born overseas, compared to White UK-born (e.g. White overseas-born, aOR 0.68, 95%CI 0.55-0.83; Asian overseas-born aOR 0.75, 95%CI 0.62-0.90; Black overseas-born aOR 0.52, 95%CI 0.36-0.74). The odds of MLTCs in overseas-born HCWs were equivalent to the UK-born population in those who had settled in the UK for ≥ 20 years (aOR 1.14, 95%CI 0.94-1.37). CONCLUSIONS Among UK HCWs, the prevalence of common LTCs and odds of reporting MLTCs varied by ethnicity and migrant status. The lower odds of MLTCs in migrant HCWs reverted to the odds of MLTCs in UK-born HCWs over time. Further research on this population should include longitudinal studies with linkage to healthcare records. Interventions should be co-developed with HCWs from different ethnic and migrant groups focussed upon patterns of conditions prevalent in specific HCW subgroups to reduce the overall burden of LTCs/MLTCs.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK
- School of Social Sciences and Humanities, Aston University, Birmingham, UK
| | - Christopher A Martin
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Rebecca F Baggaley
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Shirley Sze
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
| | | | - Laura J Gray
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK
| | - Manish Pareek
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK.
- Development Centre for Population Health, University of Leicester, Leicester, UK.
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Martin CA, Medisauskaite A, Gogoi M, Teece L, Nazareth J, Pan D, Carr S, Khunti K, Nellums LB, Woolf K, Pareek M. Discrimination, feeling undervalued, and health-care workforce attrition: an analysis from the UK-REACH study. Lancet 2023; 402:845-848. [PMID: 37604176 DOI: 10.1016/s0140-6736(23)01365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| | | | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Lucy Teece
- University College London Medical School, London, UK; Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK; Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Sue Carr
- General Medical Council, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK
| | - Laura B Nellums
- Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK; NIHR Applied Research Collaboration East Midlands, Leicester, UK.
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Al-Oraibi A, Woolf K, Fatimah S, Pareek M. Healthcare workers must be included in long covid research in the UK. BMJ 2023; 382:p1721. [PMID: 37495241 DOI: 10.1136/bmj.p1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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McBride M, Martin CA, Teece L, Irizar P, Batson M, Lagrata S, Papineni P, Nazareth J, Pan D, Leary A, Woolf K, Pareek M. Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study. BJPsych Open 2023; 9:e124. [PMID: 37434497 PMCID: PMC10375869 DOI: 10.1192/bjo.2023.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Exploration of the association between financial concerns and depression in UK healthcare workers (HCWs) is paramount given the current 'cost of living crisis', ongoing strike action and recruitment/retention problems in the National Health Service. AIMS To assess the impact of financial concerns on the risk of depression in HCWs, how these concerns have changed over time and what factors might predict financial concerns. METHOD We used longitudinal survey data from a UK-wide cohort of HCWs to determine whether financial concerns at baseline (December 2020 to March 2021) were associated with depression (measured with the Public Health Questionnaire-2) at follow-up (June to October 2022). We used logistic regression to examine the association between financial concerns and depression, and ordinal logistic regression to establish predictors of developing financial concerns. RESULTS A total of 3521 HCWs were included. Those concerned about their financial situation at baseline had higher odds of developing depressive symptoms at follow-up. Financial concerns increased in 43.8% of HCWs and decreased in 9%. Those in nursing, midwifery and other nursing roles had over twice the odds of developing financial concerns compared with those in medical roles. CONCLUSIONS Financial concerns are increasing in prevalence and predict the later development of depressive symptoms in UK HCWs. Those in nursing, midwifery and other allied nursing roles may have been disproportionately affected. Our results are concerning given the potential effects on sickness absence and staff retention. Policy makers should act to alleviate financial concerns to reduce the impact this may have on a discontent workforce plagued by understaffing.
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Affiliation(s)
- Martin McBride
- Department of Psychiatry, Leicester Partnership NHS Trust, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, UK; and Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Lucy Teece
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, UK
| | - Patricia Irizar
- Department of Sociology, School of Social Sciences, Faculty of Humanities, University of Manchester, UK
| | - Megan Batson
- Leicester Medical School, University of Leicester, UK
| | - Susie Lagrata
- Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, UK; and Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK; Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK; and Li Ka Shing Institute for Health Information and Discovery, Oxford Big Data Institute, UK
| | - Alison Leary
- Department of Health and Social Care, London South Bank University, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK; and Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
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Martin CA, Woolf K, Bryant L, Goss C, Gogoi M, Lagrata S, Papineni P, Qureshi I, Wobi F, Nellums L, Khunti K, Pareek M. Coverage, completion and outcomes of COVID-19 risk assessments in a multi-ethnic nationwide cohort of UK healthcare workers: a cross-sectional analysis from the UK-REACH Study. Occup Environ Med 2023:oemed-2022-108700. [PMID: 37221040 DOI: 10.1136/oemed-2022-108700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION There are limited data on the outcomes of COVID-19 risk assessment in healthcare workers (HCWs) or the association of ethnicity, other sociodemographic and occupational factors with risk assessment outcomes. METHODS We used questionnaire data from UK-REACH (UK Research study into Ethnicity And COVID-19 outcomes in Healthcare workers), an ethnically diverse, nationwide cohort of UK HCWs. We derived four binary outcomes: (1) offered a risk assessment; (2) completed a risk assessment; (3) working practices changed as a result of the risk assessment; (4) wanted changes to working practices after risk assessment but working practices did not change.We examined the association of ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk variables on our outcomes using multivariable logistic regression. RESULTS 8649 HCWs were included in total. HCWs from ethnic minority groups were more likely to report being offered a risk assessment than white HCWs, and those from Asian and black ethnic groups were more likely to report having completed an assessment if offered. Ethnic minority HCWs had lower odds of reporting having their work change as a result of risk assessment. Those from Asian and black ethnic groups were more likely to report no changes to their working practices despite wanting them.Previous SARS-CoV-2 infection was associated with lower odds of being offered a risk assessment and having adjustments made to working practices. DISCUSSION We found differences in risk assessment outcomes by ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk factors. These findings are concerning and warrant further research using actual (rather than reported) risk assessment outcomes in an unselected cohort.
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Affiliation(s)
- Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London Medical School, London, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charles Goss
- Department of Occupational Health, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Susie Lagrata
- Queen Square Insitute of Neurology and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Harrow, UK
| | - Irtiza Qureshi
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Fatimah Wobi
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
- School of Law, University of Leicester, Leicester, UK
| | - Laura Nellums
- Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Woolf K, Papineni P, Lagrata S, Pareek M. Retention of ethnic minority staff is critical to resolving the NHS workforce crisis. BMJ 2023; 380:541. [PMID: 36898716 DOI: 10.1136/bmj.p541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
| | | | | | - Manish Pareek
- University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
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7
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Bryant L, Free RC, Woolf K, Melbourne C, Guyatt AL, John C, Gupta A, Gray LJ, Nellums L, Martin CA, McManus IC, Garwood C, Modhawdia V, Carr S, Wain LV, Tobin MD, Khunti K, Akubakar I, Pareek M. Cohort Profile: The United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH). Int J Epidemiol 2023; 52:e38-e45. [PMID: 36029521 PMCID: PMC9452183 DOI: 10.1093/ije/dyac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Robert C Free
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anna L Guyatt
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Catherine John
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Amit Gupta
- Oxford Teaching Hospitals NHS Foundation Trust, Oxford, UK
| | - Laura J Gray
- Biostatistics research group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Laura Nellums
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Claire Garwood
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Vishant Modhawdia
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sue Carr
- General Medical Council, London, UK.,Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Louise V Wain
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Martin D Tobin
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ibrahim Akubakar
- Faculty of Pop Health Sciences, School of Life & Medical Sciences, University College London, London, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Al-Oraibi A, Naidu JS, Chaka A, Woolf K, B Nellums L, Tarrant C, Pan D, Sze S, Martin CA, Gogoi M, Nazareth J, Pareek M. Prevalence of long COVID-19 among healthcare workers: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e065234. [PMID: 36600349 PMCID: PMC9729843 DOI: 10.1136/bmjopen-2022-065234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A proportion of those who survive the acute phase of COVID-19 experience prolonged symptoms, commonly known as long COVID-19. Given that healthcare workers (HCWs) face an elevated risk of acute COVID-19 compared with the general population, the global burden of long COVID-19 in HCWs is likely to be large; however, there is limited understanding of the prevalence of long COVID-19 in HCWs, or its symptoms and their clustering. This review will aim to estimate the pooled prevalence and the symptoms of long COVID-19 among HCWs infected with SARS-CoV-2 globally, and investigate differences by country, age, sex, ethnicity, vaccination status and occupation. METHODS AND ANALYSIS A systematic review and meta-analysis will be conducted. Medline (via Ovid), CINAHL (via EBSCO), Embase (via Ovid), PsycINFO (via EBSCO), OpenGrey (grey literature) and medRxiv (preprint server) will be searched from the 31 December 2019 onward. All research studies and preprint articles reporting any primary data on the prevalence and/or the symptoms of long COVID-19 among adult HCWs will be included. Methodological quality will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Outcomes are anticipated to be the prevalence of long COVID-19 among HCWs around the world and trajectory of symptoms. Data synthesis will include random-effect meta-analysis for studies reporting prevalence data of long COVID-19 following SARS-CoV-2 infection among HCWs. The results will be presented with a 95% CI as an estimated effect across studies. Heterogeneity will be assessed using I² statistic. Where meta-analysis is inappropriate, a narrative synthesis of the evidence will be conducted. ETHICS AND DISSEMINATION Ethical approval is not needed as data will be obtained from published articles. We will publish our findings in a peer-reviewed journal and disseminate the results of our review at conferences. PROSPERO REGISTRATION NUMBER CRD42022312781.
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Affiliation(s)
- Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Aasiya Chaka
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Laura B Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Rees EL, Mattick K, Harrison D, Rich A, Woolf K. 'I'd have to fight for my life there': a multicentre qualitative interview study of how socioeconomic background influences medical school choice. Med Educ Online 2022; 27:2118121. [PMID: 36048126 PMCID: PMC9448433 DOI: 10.1080/10872981.2022.2118121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Students from lower socio-economic backgrounds who were educated in state funded schools are underrepresented in medicine in the UK. Widening access to medical students from these backgrounds has become a key political and research priority. It is known that medical schools vary in the number of applicants attracted and accepted from non-traditional backgrounds but the reasons for this are poorly understood. This study aims to explore what applicants value when choosing medical schools to apply to and how this relates to their socioeconomic background. We conducted a multicentre qualitative interview study, purposively sampling applicants and recent entrants based on socioeconomic background, stage of application and medical school of application. We recruited participants from eight UK medical schools. Participants attended semi-structured interviews. We performed a framework analysis, identifying codes inductively from the data. Sixty-six individuals participated: 35 applicants and 31 first year medical students. Seven main themes were identified; course style, proximity to home, prestige, medical school culture, geographical area, university resources, and fitting in. These were prioritised differently depending on participants' background. Participants from lower socioeconomic backgrounds described proximity to home as a higher priority. This was typically as they intended to be living at home for at least part of the course. Those from higher socioeconomic backgrounds were more concerned with the perceived prestige of medical schools. Since medicine is a highly selective course, only offered at a minority of UK higher education institutions, these differences in priorities may help explain observed differential patterns of medical school applications and success rates by applicant social background.
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Affiliation(s)
- Eliot L Rees
- Research Department of Medical Education, University College London, London, UK
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Karen Mattick
- Department of Health & Community Sciences, University of Exeter, Exeter, UK
| | - David Harrison
- Research Department of Medical Education, University College London, London, UK
| | - Antonia Rich
- Research Department of Medical Education, University College London, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London, London, UK
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Veli N, Martin CA, Woolf K, Nazareth J, Pan D, Al-Oraibi A, Baggaley RF, Bryant L, Nellums LB, Gray LJ, Khunti K, Pareek M. Hesitancy for receiving regular SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis from the UK-REACH study. BMC Med 2022; 20:386. [PMID: 36210437 PMCID: PMC9548389 DOI: 10.1186/s12916-022-02588-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Regular vaccination against SARS-CoV-2 may be needed to maintain immunity in 'at-risk' populations, which include healthcare workers (HCWs). However, little is known about the proportion of HCWs who might be hesitant about receiving a hypothetical regular SARS-CoV-2 vaccination or the factors associated with this hesitancy. METHODS Cross-sectional analysis of questionnaire data collected as part of UK-REACH, a nationwide, longitudinal cohort study of HCWs. The outcome measure was binary, either a participant indicated they would definitely accept regular SARS-CoV-2 vaccination if recommended or they indicated some degree of hesitancy regarding acceptance (probably accept or less likely). We used logistic regression to identify factors associated with hesitancy for receiving regular vaccination. RESULTS A total of 5454 HCWs were included in the analysed cohort, 23.5% of whom were hesitant about regular SARS-CoV-2 vaccination. Black HCWs were more likely to be hesitant than White HCWs (aOR 2.60, 95%CI 1.80-3.72) as were those who reported a previous episode of COVID-19 (1.33, 1.13-1.57 [vs those who tested negative]). Those who received influenza vaccination in the previous two seasons were over five times less likely to report hesitancy for regular SARS-CoV-2 vaccination than those not vaccinated against influenza in either season (0.18, 0.14-0.21). HCWs who trusted official sources of vaccine information (such as NHS or government adverts or websites) were less likely to report hesitancy for a regular vaccination programme. Those who had been exposed to information advocating against vaccination from friends and family were more likely to be hesitant. CONCLUSIONS In this study, nearly a quarter of UK HCWs were hesitant about receiving a regular SARS-CoV-2 vaccination. We have identified key factors associated with hesitancy for regular SARS-CoV-2 vaccination, which can be used to identify groups of HCWs at the highest risk of vaccine hesitancy and tailor interventions accordingly. Family and friends of HCWs may influence decisions about regular vaccination. This implies that working with HCWs and their social networks to allay concerns about SARS-CoV-2 vaccination could improve uptake in a regular vaccination programme. TRIAL REGISTRATION ISRCTN Registry, ISRCTN11811602.
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Affiliation(s)
- Neyme Veli
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rebecca F Baggaley
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Laura B Nellums
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Laura J Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
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11
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Harrison D, McManus IC, Rees EL, Woolf K. Institutional choice among medical applicants: a profile paper for The United Kingdom Medical Applicant Cohort Study (UKMACS) prospective longitudinal cohort study. BMJ Open 2022; 12:e060135. [PMID: 36167376 PMCID: PMC9516324 DOI: 10.1136/bmjopen-2021-060135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To generate a large cohort of those in 2019 seriously considering applying to study Medicine, collecting data on a range of socioeconomic and other demographic factors that influence choice of medical schools and to link to other datasets to form a longitudinal study of progress through medical school and careers in medicine. DESIGN Cross-sectional questionnaire studies, part of the longitudinal UK Medical Applicant Cohort Study (UKMACS). SETTING UK medical school admissions in 2020. PARTICIPANTS UK residents aged 16+ and seriously considering applying to study Medicine. The cohort was primarily drawn from those registering in 2019 for the U(K)CAT (University Clinical Aptitude Test (formerly the UK Clinical Aptitude Test)) with additional potential applicants responding to an open call. Participants consented to their data being linked within the UK Medical Education Database. FINDINGS TO DATE UKMACS Wave 1 questionnaire respondents consisted of 6391 consenting respondents from across the UK. In 2019, 14 980 of the 17 470 UK-domiciled medicine applicants were first-time applicants. The questionnaires show that many of these applicants have a need for more help and guidance to make informed choices, with less advantaged groups reporting themselves as being at a disadvantage when applying due to limited understanding of information and limited access to guidance to enable informed and effective decision-making. FUTURE PLANS To link the cohort with successive Universities and Colleges Admissions Service and other datasets to analyse outcomes of applications and establish national longitudinal evidence to understand how medical choices are made and how they impact on educational, career and workforce outcomes.
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Affiliation(s)
- David Harrison
- Research Department for Medical Education, University College London, London, UK
| | - I C McManus
- Research Department for Medical Education, University College London, London, UK
| | - Eliot L Rees
- School of Medicine, Keele University, Staffordshire, UK
- Faculty of Population Health Sciences, University College London, London, UK
| | - Katherine Woolf
- Research Department for Medical Education, University College London, London, UK
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12
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Herbert S, Adintori P, Woolf K. Beliefs, Practice Behaviors, Facilitators, and Barriers to the Recommendation of Cannabis in Dietetics Practice. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Webb A, Gogoi M, Weidman S, Woolf K, Zavala M, Ladhani SN, Pareek M, Gies L, Bayliss CD. Cross-Sectional Study of University Students’ Attitudes to ‘On Campus’ Delivery of COVID-19, MenACWY and MMR Vaccines and Future-Proofing Vaccine Roll-Out Strategies. Vaccines (Basel) 2022; 10:vaccines10081287. [PMID: 36016175 PMCID: PMC9415485 DOI: 10.3390/vaccines10081287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
University students are a critical group for vaccination programmes against COVID-19, meningococcal disease (MenACWY) and measles, mumps and rubella (MMR). We aimed to evaluate risk factors for vaccine hesitancy and views about on-campus vaccine delivery among university students. Data were obtained through a cross-sectional anonymous online questionnaire study of undergraduate students in June 2021 and analysed by univariate and multivariate tests to detect associations. Complete data were obtained from 827 participants (7.6% response-rate). Self-reporting of COVID-19 vaccine status indicated uptake by two-thirds (64%; 527/827), willing for 23% (194/827), refusal by 5% (40/827) and uncertain results for 8% (66/827). Hesitancy for COVID-19 vaccines was 5% (40/761). COVID-19 vaccine hesitancy was associated with Black ethnicity (aOR, 7.01, 95% CI, 1.8–27.3) and concerns about vaccine side-effects (aOR, 1.72; 95% CI, 1.23–2.39). Uncertainty about vaccine status was frequently observed for MMR (11%) and MenACWY (26%) vaccines. Campus-associated COVID-19 vaccine campaigns were favoured by UK-based students (definitely, 45%; somewhat, 16%) and UK-based international students (definitely, 62%; somewhat, 12%). Limitations of this study were use of use of a cross-sectional approach, self-selection of the response cohort, slight biases in the demographics and a strict definition of vaccine hesitancy. Vaccine hesitancy and uncertainty about vaccine status are concerns for effective vaccine programmes. Extending capabilities of digital platforms for accessing vaccine information and sector-wide implementation of on-campus vaccine delivery are strategies for improving vaccine uptake among students. Future studies of vaccine hesitancy among students should aim to extend our observations to student populations in a wider range of university settings and with broader definitions of vaccine hesitancy.
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Affiliation(s)
- Adam Webb
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Sarah Weidman
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Katherine Woolf
- Faculty of Medicine, University College London Medical School, London WC1E 6DE, UK
| | - Maria Zavala
- Immunisation and Countermeasures Division, Public Health England Colindale, London NW9 5EQ, UK
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, Public Health England Colindale, London NW9 5EQ, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Lieve Gies
- School of Media, Communication and Sociology, University of Leicester, Leicester LE1 7RH, UK
| | - Christopher D. Bayliss
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
- Correspondence: ; Tel.: +44-116-2523465
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14
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Martin CA, Pan D, Nazareth J, Aujayeb A, Bryant L, Carr S, Gray LJ, Gregary B, Gupta A, Guyatt AL, Gopal A, Hine T, John C, McManus IC, Melbourne C, Nellums LB, Reza R, Simpson S, Tobin MD, Woolf K, Zingwe S, Khunti K, Pareek M. Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH). BMC Health Serv Res 2022; 22:867. [PMID: 35790970 PMCID: PMC9255515 DOI: 10.1186/s12913-022-08202-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/15/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic. METHODS We conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis). RESULTS Ten thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67-0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61-0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis. CONCLUSIONS Only a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic.
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Affiliation(s)
- Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sue Carr
- University Hospitals Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
- General Medical Council, London, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bindu Gregary
- Lancashire Clinical Research Facility, Royal Preston Hospital, Fulwood, UK
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anna L Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alan Gopal
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Thomas Hine
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Carl Melbourne
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Laura B Nellums
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rubina Reza
- Centre for Research & Development, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Sandra Simpson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Stephen Zingwe
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
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15
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Al-Oraibi A, Woolf K, Nellums LB, Tarrant C, Naqvi H, Pareek M. Caring for the carers: understanding long covid in our diverse healthcare workforce. BMJ 2022; 377:o1152. [PMID: 35523438 DOI: 10.1136/bmj.o1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Laura B Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
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16
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Martin CA, Pan D, Melbourne C, Teece L, Aujayeb A, Baggaley RF, Bryant L, Carr S, Gregary B, Gupta A, Guyatt AL, John C, McManus IC, Nazareth J, Nellums LB, Reza R, Simpson S, Tobin MD, Woolf K, Zingwe S, Khunti K, Abrams KR, Gray LJ, Pareek M. Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis. PLoS Med 2022; 19:e1004015. [PMID: 35617423 PMCID: PMC9187071 DOI: 10.1371/journal.pmed.1004015] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/10/2022] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs. METHODS AND FINDINGS We conducted a cross-sectional analysis using data from the baseline questionnaire of the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH) cohort study, administered between December 2020 and March 2021. We used logistic regression to examine associations of demographic, household, and occupational risk factors with SARS-CoV-2 infection (defined by polymerase chain reaction (PCR), serology, or suspected COVID-19) in a diverse group of HCWs. The primary exposure of interest was self-reported ethnicity. Among 10,772 HCWs who worked during the first UK national lockdown in March 2020, the median age was 45 (interquartile range [IQR] 35 to 54), 75.1% were female and 29.6% were from ethnic minority groups. A total of 2,496 (23.2%) reported previous SARS-CoV-2 infection. The fully adjusted model contained the following dependent variables: demographic factors (age, sex, ethnicity, migration status, deprivation, religiosity), household factors (living with key workers, shared spaces in accommodation, number of people in household), health factors (presence/absence of diabetes or immunosuppression, smoking history, shielding status, SARS-CoV-2 vaccination status), the extent of social mixing outside of the household, and occupational factors (job role, the area in which a participant worked, use of public transport to work, exposure to confirmed suspected COVID-19 patients, personal protective equipment [PPE] access, aerosol generating procedure exposure, night shift pattern, and the UK region of workplace). After adjustment, demographic and household factors associated with increased odds of infection included younger age, living with other key workers, and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.59, 95% CI 2.11 to 3.18 for ≥21 patients per week versus none), working in a nursing or midwifery role (1.30, 1.11 to 1.53, compared to doctors), reporting a lack of access to PPE (1.29, 1.17 to 1.43), and working in an ambulance (2.00, 1.56 to 2.58) or hospital inpatient setting (1.55, 1.38 to 1.75). Those who worked in intensive care units were less likely to have been infected (0.76, 0.64 to 0.92) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known risk factors. This study is limited by self-selection bias and the cross sectional nature of the study means we cannot infer the direction of causality. CONCLUSIONS We identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection among UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic. TRIAL REGISTRATION The study was prospectively registered at ISRCTN (reference number: ISRCTN11811602).
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Affiliation(s)
- Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Lucy Teece
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, United Kingdom
| | - Rebecca F. Baggaley
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- General Medical Council, London, United Kingdom
| | - Bindu Gregary
- Lancashire Clinical Research Facility, Royal Preston Hospital, United Kingdom
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Anna L. Guyatt
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - I Chris McManus
- University College London Medical School, London, United Kingdom
| | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Laura B. Nellums
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rubina Reza
- Centre for Research & Development, Derbyshire Healthcare NHS Foundation Trust, Derby, United Kingdom
| | - Sandra Simpson
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Martin D. Tobin
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Katherine Woolf
- University College London Medical School, London, United Kingdom
| | - Stephen Zingwe
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Keith R. Abrams
- Department of Statistics, University of Warwick, United Kingdom
| | - Laura J. Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Woolf K, Gogoi M, Martin CA, Papineni P, Lagrata S, Nellums LB, McManus I, Guyatt AL, Melbourne C, Bryant L, Gupta A, John C, Carr S, Tobin MD, Simpson S, Gregary B, Aujayeb A, Zingwe S, Reza R, Gray LJ, Khunti K, Pareek M. Healthcare workers' views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study. EClinicalMedicine 2022; 46:101346. [PMID: 35308309 PMCID: PMC8923694 DOI: 10.1016/j.eclinm.2022.101346] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Several countries now have mandatory SARS-CoV-2 vaccination for healthcare workers (HCWs) or the general population. HCWs' views on this are largely unknown. Using data from the nationwide UK-REACH study we aimed to understand UK HCW's views on improving SARS-CoV-2 vaccination coverage, including mandatory vaccination. Methods Between 21st April and 26th June 2021, we administered an online questionnaire via email to 17 891 UK HCWs recruited as part of a longitudinal cohort from across the UK who had previously responded to a baseline questionnaire (primarily recruited through email) as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) nationwide prospective cohort study. We categorised responses to a free-text question "What should society do if people do not get vaccinated against COVID-19?" using qualitative content analysis. We collapsed categories into a binary variable: favours mandatory vaccination or not, using logistic regression to calculate its demographic predictors, and its occupational, health, and attitudinal predictors adjusted for demographics. Findings Of 5633 questionnaire respondents, 3235 answered the free text question. Median age of free text responders was 47 years (IQR 36-56) and 2705 (74.3%) were female. 18% (n = 578) favoured mandatory vaccination (201 [6%] participants for HCWs and others working with vulnerable populations; 377 [12%] for the general population), but the most frequent suggestion was education (32%, n = 1047). Older HCWs (OR 1.84; 95% CI 1.44-2.34 [≥55 years vs 16 years to <40 years]), HCWs vaccinated against influenza (OR 1.49; 95% CI 1.11-2.01 [2 vaccines vs none]), and with more positive vaccination attitudes generally (OR 1.10; 95% CI 1.06-1.15) were more likely to favour mandatory vaccination, whereas female HCWs (OR= 0.79, 95% CI 0.63-0.96, vs male HCWs) and Black HCWs (OR=0.46, 95% CI 0.25-0.85, vs white HCWs) were less likely to. Interpretation Only one in six of the HCWs in this large, diverse, UK-wide sample favoured mandatory vaccination. Building trust, educating, and supporting HCWs who are hesitant about vaccination may be more acceptable, effective, and equitable. Funding MRC-UK Research and Innovation grant (MR/V027549/1) and the Department of Health and Social Care (DHSC) via the National Institute for Health Research (NIHR). Core funding was also provided by NIHR Biomedical Research Centres.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, University College London Medical School, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
| | - Padmasayee Papineni
- Ealing Hospital, London North West University Healthcare NHS Trust, Southall, UK
| | - Susie Lagrata
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura B. Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - I.Chris McManus
- Research Department of Medical Education, University College London Medical School, UK
| | - Anna L. Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sue Carr
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, UK
- General Medical Council, UK
| | - Martin D. Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Bindu Gregary
- Lancashire Clinical Research Facility, Royal Preston Hospital, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, UK
| | - Stephen Zingwe
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust
| | - Rubina Reza
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, UK
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
| | - UK-REACH Study Collaborative Group
- Research Department of Medical Education, University College London Medical School, UK
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
- Department of Infection and HIV Medicine, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Jarvis Building, Leicester LE1 5WW, UK
- Ealing Hospital, London North West University Healthcare NHS Trust, Southall, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Oxford University Hospitals NHS Foundation Trust, UK
- Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, UK
- General Medical Council, UK
- Nottinghamshire Healthcare NHS Foundation Trust, UK
- Lancashire Clinical Research Facility, Royal Preston Hospital, UK
- Respiratory Department, Northumbria Specialist Emergency Care Hospital, UK
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, UK
- Diabetes Research Centre, University of Leicester, UK
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Harvey PR, Phillips C, Newbery N, Nagamoottoo D, Woolf K, Trudgill NJ. Ethnic differences in success at application for consultant posts among United Kingdom physicians from 2011 to 2019: a retrospective cross-sectional observational study. J R Soc Med 2022; 115:300-312. [PMID: 35357252 DOI: 10.1177/01410768221085691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify associations between success following application for consultant physician posts and demographic factors. DESIGN Logistic regression analysis of nationwide survey data. SETTING United Kingdom (UK) physicians with a recent certificate of completion of training (CCT). PARTICIPANTS All UK trainee physicians who received a CCT between 2010 and 2019 were surveyed. Respondents were excluded if they had not applied for a consultant post or if application data were incomplete. MAIN OUTCOME MEASURES The primary outcome measure was success over the entire consultant application process, i.e. shortlisted and offered the post following the first application. Secondary outcomes were: shortlisted following first application and offered a consultant post at first interview. RESULTS From 7037 CCT holders surveyed, 50.7% responded. While 1198 (59.7%) respondents were white, 760 (37.9%) were from minority ethnic groups and 50 (3.5%) were of unknown ethnicity. Primary medical qualification (PMQ) country was the UK in 75.3% (n = 1512). On multivariable logistic regression analysis the independent negative associations with success were: minority ethnicity (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.43-0.71); p < 0.001) vs. white; PMQ from Europe (OR 0.47, 95% CI 0.28-0.79; p = 0.004) or Asia (OR 0.68, 95% CI 0.49-0.96; p = 0.027) vs. UK PMQ; year of CCT 2012 (OR 0.40, 95% CI 0.24-0.68; p = 0.001), 2013 (OR 0.39, 95% CI 0.23-0.65; p < 0.001), and 2014 (OR 0.26, 95% CI 0.15-0.43; p < 0.001) vs. 2019. Specialties associated with lower success rates included Cardiology, Endocrinology, Genitourinary medicine, Palliative care, Renal and Respiratory, compared to Acute medicine. CONCLUSIONS Minority ethnic group candidates for consultant physician posts had lower success rates compared to white candidates after correction for important variables including specialty, time from and country of PMQ. This finding requires further evaluation to identify the causes for this variation.
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Affiliation(s)
- P R Harvey
- The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Phillips
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK
| | - N Newbery
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK
| | - D Nagamoottoo
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK
| | - K Woolf
- Research Department of Medical Education, University College London Medical School, London, WC1E 6BT, UK
| | - N J Trudgill
- Medical Workforce Unit, Royal College of Physicians, London, NW1 4LE,UK.,Sandwell and West Birmingham NHS Trust, West Bromwich, B71 4HJ, UK
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Martin CA, Woolf K, Bryant L, Carr S, Gray LJ, Gupta A, Guyatt AL, John C, Melbourne C, McManus IC, Nazareth J, Nellums LB, Tobin MD, Pan D, Khunti K, Pareek M. Persistent hesitancy for SARS-CoV-2 vaccines among healthcare workers in the United Kingdom: analysis of longitudinal data from the UK-REACH cohort study. Lancet Reg Health Eur 2022; 13:100299. [PMID: 35013731 PMCID: PMC8730737 DOI: 10.1016/j.lanepe.2021.100299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
- General Medical Council, London, UK
| | - Laura J. Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anna L. Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Joshua Nazareth
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura B. Nellums
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Martin D. Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - UK-REACH Study Collaborative Group
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- University College London Medical School, London, UK
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
- General Medical Council, London, UK
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
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20
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Qureshi I, Gogoi M, Al-Oraibi A, Wobi F, Pan D, Martin CA, Chaloner J, Woolf K, Pareek M, Nellums LB. Intersectionality and developing evidence-based policy. Lancet 2022; 399:355-356. [PMID: 35065780 PMCID: PMC8776279 DOI: 10.1016/s0140-6736(21)02801-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Irtiza Qureshi
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Amani Al-Oraibi
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Jonathan Chaloner
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK.
| | - Laura B Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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21
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McManus IC, Woolf K, Harrison D, Tiffin PA, Paton LW, Cheung KYF, Smith DT. Predictive validity of A-level grades and teacher-predicted grades in UK medical school applicants: a retrospective analysis of administrative data in a time of COVID-19. BMJ Open 2021; 11:e047354. [PMID: 34916308 PMCID: PMC8678544 DOI: 10.1136/bmjopen-2020-047354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 09/17/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To compare in UK medical students the predictive validity of attained A-level grades and teacher-predicted A levels for undergraduate and postgraduate outcomes. Teacher-predicted A-level grades are a plausible proxy for the teacher-estimated grades that replaced UK examinations in 2020 as a result of the COVID-19 pandemic. The study also models the likely future consequences for UK medical schools of replacing public A-level examination grades with teacher-predicted grades. DESIGN Longitudinal observational study using UK Medical Education Database data. SETTING UK medical education and training. PARTICIPANTS Dataset 1: 81 202 medical school applicants in 2010-2018 with predicted and attained A-level grades. Dataset 2: 22 150 18-year-old medical school applicants in 2010-2014 with predicted and attained A-level grades, of whom 12 600 had medical school assessment outcomes and 1340 had postgraduate outcomes available. OUTCOME MEASURES Undergraduate and postgraduate medical examination results in relation to attained and teacher-predicted A-level results. RESULTS Dataset 1: teacher-predicted grades were accurate for 48.8% of A levels, overpredicted in 44.7% of cases and underpredicted in 6.5% of cases. Dataset 2: undergraduate and postgraduate outcomes correlated significantly better with attained than with teacher-predicted A-level grades. Modelling suggests that using teacher-estimated grades instead of attained grades will mean that 2020 entrants are more likely to underattain compared with previous years, 13% more gaining the equivalent of the lowest performance decile and 16% fewer reaching the equivalent of the current top decile, with knock-on effects for postgraduate training. CONCLUSIONS The replacement of attained A-level examination grades with teacher-estimated grades as a result of the COVID-19 pandemic may result in 2020 medical school entrants having somewhat lower academic performance compared with previous years. Medical schools may need to consider additional teaching for entrants who are struggling or who might need extra support for missed aspects of A-level teaching.
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Affiliation(s)
- I C McManus
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, UCL Medical School, London, UK
| | - David Harrison
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Paul A Tiffin
- Department of Health Sciences, University of York, York, UK
- Health Professions Education Unit, Hull York Medical School, Hull, UK
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, UK
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22
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Pan D, Sze S, Martin CA, Nazareth J, Woolf K, Baggaley RF, Hollingsworth TD, Khunti K, Nellums LB, Pareek M. Covid-19 and ethnicity: we must seek to understand the drivers of higher transmission. BMJ 2021; 375:n2709. [PMID: 34740938 DOI: 10.1136/bmj.n2709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel Pan
- Department of Respiratory Sciences, University of Leicester
| | - Shirley Sze
- Department of cardiovascular science, University of Leicester
| | | | | | | | | | | | - Kamlesh Khunti
- Department of cardiovascular science, University of Leicester
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester
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23
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Woolf K, McManus IC, Martin CA, Nellums LB, Guyatt AL, Melbourne C, Bryant L, Gogoi M, Wobi F, Al-Oraibi A, Hassan O, Gupta A, John C, Tobin MD, Carr S, Simpson S, Gregary B, Aujayeb A, Zingwe S, Reza R, Gray LJ, Khunti K, Pareek M. Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: Results from the UK-REACH prospective nationwide cohort study. Lancet Reg Health Eur 2021; 9:100180. [PMID: 34308406 PMCID: PMC8287519 DOI: 10.1016/j.lanepe.2021.100180] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In most countries, healthcare workers (HCWs) represent a priority group for vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) due to their elevated risk of COVID-19 and potential contribution to nosocomial SARS-CoV-2 transmission. Concerns have been raised that HCWs from ethnic minority groups are more likely to be vaccine hesitant (defined by the World Health Organisation as refusing or delaying a vaccination) than those of White ethnicity, but there are limited data on SARS-CoV-2 vaccine hesitancy and its predictors in UK HCWs. METHODS Nationwide prospective cohort study and qualitative study in a multi-ethnic cohort of clinical and non-clinical UK HCWs. We analysed ethnic differences in SARS-CoV-2 vaccine hesitancy adjusting for demographics, vaccine trust, and perceived risk of COVID-19. We explored reasons for hesitancy in qualitative data using a framework analysis. FINDINGS 11,584 HCWs were included in the cohort analysis. 23% (2704) reported vaccine hesitancy. Compared to White British HCWs (21.3% hesitant), HCWs from Black Caribbean (54.2%), Mixed White and Black Caribbean (38.1%), Black African (34.4%), Chinese (33.1%), Pakistani (30.4%), and White Other (28.7%) ethnic groups were significantly more likely to be hesitant. In adjusted analysis, Black Caribbean (aOR 3.37, 95% CI 2.11 - 5.37), Black African (aOR 2.05, 95% CI 1.49 - 2.82), White Other ethnic groups (aOR 1.48, 95% CI 1.19 - 1.84) were significantly more likely to be hesitant. Other independent predictors of hesitancy were younger age, female sex, higher score on a COVID-19 conspiracy beliefs scale, lower trust in employer, lack of influenza vaccine uptake in the previous season, previous COVID-19, and pregnancy. Qualitative data from 99 participants identified the following contributors to hesitancy: lack of trust in government and employers, safety concerns due to the speed of vaccine development, lack of ethnic diversity in vaccine studies, and confusing and conflicting information. Participants felt uptake in ethnic minority communities might be improved through inclusive communication, involving HCWs in the vaccine rollout, and promoting vaccination through trusted networks. INTERPRETATION Despite increased risk of COVID-19, HCWs from some ethnic minority groups are more likely to be vaccine hesitant than their White British colleagues. Strategies to build trust and dispel myths surrounding the COVID-19 vaccine in these communities are urgently required. Emphasis should be placed on the safety and benefit of SARS-CoV-2 vaccination in pregnancy and in those with previous COVID-19. Public health communications should be inclusive, non-stigmatising and utilise trusted networks. FUNDING UKRI-MRC and NIHR.
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Affiliation(s)
| | | | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | - Anna L Guyatt
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Carl Melbourne
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, United Kingdom
| | - Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, United Kingdom
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, United Kingdom
| | - Amani Al-Oraibi
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | - Osama Hassan
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Catherine John
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Sue Carr
- University Hospitals Leicester NHS Trust, Leicester Royal Infirmary, United Kingdom
- General Medical Council, United Kingdom
| | - Sandra Simpson
- Nottinghamshire Healthcare NHS Foundation Trust, United Kingdom
| | - Bindu Gregary
- Lancashire Clinical Research Facility, Royal Preston Hospital, United Kingdom
| | - Avinash Aujayeb
- Respiratory department, Northumbria Specialist Emergency Care Hospital, United Kingdom
| | - Stephen Zingwe
- Research and Development Department, Berkshire Healthcare NHS Foundation Trust, United Kingdom
| | - Rubina Reza
- Derbyshire Healthcare NHS Foundation Trust Centre for Research and Development, Kingsway Hospital site, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, United Kingdom
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, United Kingdom
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24
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Woolf K, Melbourne C, Bryant L, Guyatt AL, McManus IC, Gupta A, Free RC, Nellums L, Carr S, John C, Martin CA, Wain LV, Gray LJ, Garwood C, Modhwadia V, Abrams KR, Tobin MD, Khunti K, Pareek M. The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings. BMJ Open 2021; 11:e050647. [PMID: 34535484 PMCID: PMC8450967 DOI: 10.1136/bmjopen-2021-050647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers). METHODS AND ANALYSIS A baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings. ETHICS AND DISSEMINATION The study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN11811602; Pre-results.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, University College London, London, UK
| | - Carl Melbourne
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Anna L Guyatt
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - I Chris McManus
- Research Department of Medical Education, University College London, London, UK
| | - Amit Gupta
- Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Robert C Free
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | - Laura Nellums
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sue Carr
- University Hospitals of Leicester NHS Trust, Leicester, UK
- General Medical Council, London, UK
| | - Catherine John
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Christopher A Martin
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Louise V Wain
- NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Claire Garwood
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Vishant Modhwadia
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Keith R Abrams
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Martin D Tobin
- Genetic Epidemiology Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Glenfield Hospital, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Herbert S, Ganguzza L, Shah B, Newman J, Gianos E, Heffron S, Woolf K. Dietary Inflammatory Index and Cardiometabolic Risk in Individuals with Coronary Artery Disease. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Powell V, Riglin L, Ng-Knight T, Frederickson N, Woolf K, McManus C, Collishaw S, Shelton K, Thapar A, Rice F. Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent-Child Relationships Compensate? Res Child Adolesc Psychopathol 2021; 49:1031-1041. [PMID: 33655375 PMCID: PMC8222013 DOI: 10.1007/s10802-021-00798-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 01/13/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent-child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n = 1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual's classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent-child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent-child relationships. This highlights the importance of considering the quality of friendships and parent-child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.
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Woolf K, Harrison D, McManus C. The attitudes, perceptions and experiences of medical school applicants following the closure of schools and cancellation of public examinations in 2020 due to the COVID-19 pandemic: a cross-sectional questionnaire study of UK medical applicants. BMJ Open 2021; 11:e044753. [PMID: 33664080 PMCID: PMC7934197 DOI: 10.1136/bmjopen-2020-044753] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Describe the experiences and views of medical applicants from diverse social backgrounds following the closure of schools and universities and the cancellation of public examinations in the UK due to COVID-19. DESIGN Cross-sectional questionnaire study, part of the longitudinal UK Medical Applicant Cohort Study (UKMACS). SETTING UK medical school admissions in 2020. PARTICIPANTS 2887 participants completed an online questionnaire from 8 April to 22 April 2020. Eligible participants had registered to take the University Clinical Admissions Test in 2019 and agreed to be invited to take part, or had completed a previous UKMACS questionnaire, had been seriously considering applying to medicine in the UK for entry in 2020, and were UK residents. MAIN OUTCOME MEASURES Views on calculated grades, views on medical school admissions and teaching in 2020 and 2021, reported experiences of education during the national lockdown. RESULTS Respondents were concerned about the calculated grades that replaced A-level examinations: female and Black Asian and Minority Ethnic applicants felt teachers would find it difficult to grade and rank students accurately, and applicants from non-selective state schools and living in deprived areas had concerns about the standardisation process. Calculated grades were generally not considered fair enough to use in selection, but were considered fair enough to use in combination with other measures including interview and aptitude test scores. Respondents from non-selective state (public) schools reported less access to educational resources compared with private/selective school pupils, less online teaching in real time and less time studying during lockdown. CONCLUSIONS The COVID-19 pandemic has and will have significant and long-term impacts on the selection, education and performance of our medical workforce. It is important that the views and experiences of applicants from diverse backgrounds are considered in decisions affecting their future and the future of the profession.
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Affiliation(s)
- Katherine Woolf
- Research Department for Medical Education, University College London Medical School, London, UK
| | - David Harrison
- Research Department for Medical Education, University College London Medical School, London, UK
| | - Chris McManus
- Research Department for Medical Education, University College London Medical School, London, UK
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Zeina M, Balston A, Banerjee A, Woolf K. Gender and ethnic differences in publication of BMJ letters to the editor: an observational study using machine learning. BMJ Open 2020; 10:e037269. [PMID: 33371013 PMCID: PMC7754629 DOI: 10.1136/bmjopen-2020-037269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/29/2020] [Accepted: 09/23/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse the relationship between first author's gender and ethnicity (estimated from first name and surname), and chance of publication of rapid responses in the British Medical Journal (BMJ). To analyse whether other features of the rapid response account for any gender or ethnic differences, including the presence of multiple authors, declaration of conflicts of interests, the presence of Twitter handle, word count, reading ease, spelling and grammatical mistakes, and the presence of references. DESIGN A retrospective observational study. SETTING Website of the BMJ (BMJ.com). PARTICIPANTS Publicly available rapid responses submitted to BMJ.com between 1998 and 2018. MAIN OUTCOME MEASURES Publication of a rapid response as a letter to the editor in the BMJ. RESULTS We analysed 113 265 rapid responses, of which 8415 were published as letters to the editor (7.4%). Statistically significant univariate correlations were found between odds of publication and first author estimated gender and ethnicity, multiple authors, declaration of conflicts of interest, the presence of Twitter handle, word count, reading ease, spelling and grammatical mistakes, and the presence of references. Multivariate analysis showed that first author estimated gender and ethnicity predicted publication after taking into account the other factors. Compared to white authors, black authors were 26% less likely to be published (OR: 0.74, CI: 0.57-0.96), Asian and Pacific Islander authors were 46% less likely to be published (OR: 0.54, CI: 0.49-0.59) and Hispanic authors were 49% less likely to be published (OR: 0.51, CI: 0.41-0.64). Female authors were 10% less likely to be published (OR: 0.90, CI: 0.85-0.96) than male authors. CONCLUSION Ethnic and gender differences in rapid response publication remained after accounting for a broad range of features, themselves all predictive of publication. This suggests that the reasons for the differences of these groups lies elsewhere.
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Affiliation(s)
| | | | - Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London, London, UK
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Isba R, Rousseva C, Woolf K, Byrne-Davis L. Development of a brief learning environment measure for use in healthcare professions education: the Healthcare Education Micro Learning Environment Measure (HEMLEM). BMC Med Educ 2020; 20:110. [PMID: 32272934 PMCID: PMC7146917 DOI: 10.1186/s12909-020-01996-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/06/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND The learning environment impacts many aspects of healthcare education, including student outcomes. Rather than being a single and fixed phenomenon, it is made up of multiple micro learning environments. The standard clinical learning environment measurement tools do not consider such diversity and may fail to adequately capture micro learning environments. Moreover, the existing tools are often long and may take a prohibitive amount of time to complete properly. This may have a negative impact on their usefulness in educational improvement strategies. In addition, there is no universal tool available which could be utilised across several healthcare student groups and placement settings. AIM To create an evidence-based measurement tool for assessing clinical micro learning environments across several healthcare profession student groups. METHODS The measurement tool was developed through a step-wise approach: 1) literature review with iterative analysis of existing tools; 2) generation of new items via thematic analysis of student experiences; 3) a Delphi process involving healthcare educators; 4) piloting of the prototype; and 5) item reduction. RESULTS The literature review and experiential data from healthcare students resulted in 115 and 43 items respectively. These items were refined, leaving 75 items for the Delphi process, which produced a prototype with 57 items. This prototype was then completed by 257 students across the range of healthcare professions, with item reduction resulting in a 12-item tool. CONCLUSION This paper describes a mixed methods approach to developing a brief micro learning environment measurement tool. The generated tool can be used for measuring student perceptions of clinical environments across several healthcare professions. Further cross-cultural and cross-professional validation studies are needed to support widespread use, possibly through mobile application.
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Affiliation(s)
- R. Isba
- Lancaster Medical School, Lancaster University, Bailrigg, Lancaster LA1 4YW England
- Emergency Department, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB England
| | - C. Rousseva
- Royal Liverpool Hospital, Prescot Street, Liverpool, L7 8XP England
| | - K. Woolf
- Research Department of Medical Education, UCL Medical School, Gower Street, London, WC1E 6BT England
| | - L. Byrne-Davis
- Division of Medical Education, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT UK
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Ravindran S, Haycock A, Woolf K, Thomas-Gibson S. Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ Simul Technol Enhanc Learn 2020; 7:17-25. [DOI: 10.1136/bmjstel-2019-000526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
BackgroundNon-technical skills (NTS) are crucial to effective team working in endoscopy. Training in NTS has been shown to improve team performance and patient outcomes. As such, NTS training and assessment are now considered essential components of the endoscopy quality assurance process. Across the literature, other specialties have achieved this through development of behavioural marker systems (BMS). BMS provide a framework for assessing, training and measuring the NTS relevant to healthcare individuals and team. This article describes the development and impact of a novel BMS for endoscopy: the endoscopic non-technical skills (ENTS) system.MethodsThe initial NTS taxonomy for endoscopy was created through a combination of literature review, staff focus groups and semi-structured interviews, incorporating the critical decision method. Framework analysis was conducted with three individual coders and generated a skills list which formed the preliminary taxonomy. Video observation of Bowel Cancer Screening endoscopists was used to identify exemplar behaviours which were mapped to relevant skills in the NTS taxonomy. Behavioural descriptors, derived from video data, were added to form the basis of the ENTS system.ResultsA taxonomy of 33 skills in 14 separate categories were identified through framework analysis. Following video analysis and behaviour mapping, 4 overarching categories and 13 behavioural elements were identified which formed the ENTS framework. The endoscopy (directly observed procedural skills) 4-point rating scale was added to create the final ENTS system. Since its development in 2010, the ENTS system has been validated in the assessment of endoscopy for trainees nationally. ENTS informs a number of training initiatives, including a national strategy to improve NTS for all endoscopists.ConclusionsThe ENTS system is a clinically relevant tool, validated for use in trainee assessment. The use of ENTS will be important to the future of training and quality assurance in endoscopy.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital London, UK
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Rees E, Woolf K. Selection in context: The importance of clarity, transparency and evidence in achieving widening participation goals. Med Educ 2020; 54:8-10. [PMID: 31849095 DOI: 10.1111/medu.14023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Eliot Rees
- Research Department of Medical Education, University College London, London, UK
- School of Medicine, Keele University, Keele, UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London, London, UK
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Alshaikh L, Zuim A, Woolf K. Dietary and Herbal Supplement Use Among Musical Theatre Performers. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The Annual Review of Competence Progression is used to determine whether trainee doctors in the United Kingdom are safe and competent to progress to the next training stage. In this article we provide evidence to inform recommendations to enhance the validity of the summative and formative elements of the Annual Review of Competency Progression. The work was commissioned as part of a Health Education England review. We systematic searched the peer reviewed and grey literature, synthesising findings with information from national, local and specialty-specific Annual Review of Competence Progression guidance, critically evaluating the findings in the context of literature on assessing competence in medical education. National guidance lacked detail resulting in variability across locations and specialties, threatening validity and reliability. Trainees and trainers were concerned that the Annual Review of Competence Progression only reliably identifies the most poorly performing trainees. Feedback is not routinely provided, which can leave those with performance difficulties unsupported and high performers demotivated. Variability in the provision and quality of feedback can negatively affect learning. The Annual Review of Competence Progression functions as a high-stakes assessment, likely to have a significant impact on patient care. It should be subject to the same rigorous evaluation as other high-stakes assessments; there should be consistency in procedures across locations, specialties and grades; and all trainees should receive high-quality feedback.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Michael Page
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
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Woolf K, Jayaweera H, Unwin E, Keshwani K, Valerio C, Potts H. Effect of sex on specialty training application outcomes: a longitudinal administrative data study of UK medical graduates. BMJ Open 2019; 9:e025004. [PMID: 30837254 PMCID: PMC6429837 DOI: 10.1136/bmjopen-2018-025004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine sex differences in the specialty training recruitment outcomes of UK medical graduates; and whether sex differences were explained by prior academic attainment and previous fitness to practise (FtP) declarations. DESIGN Retrospective longitudinal cohort study. SETTING Administrative data on entrants to all UK medical schools from the UK Medical Education Database. PARTICIPANTS 10 559 doctors (6 155; 58% female) who entered a UK medical school in 2007 or 2008 and were eligible to apply for specialty training by 2015. PRIMARY OUTCOME MEASURE Odds of application, offer and acceptance to any specialty training programme, and on to each of the nine largest training programmes, adjusting for sex, other demographics, prior academic attainment, FtP declaration and medical school. RESULTS Across all specialties, there were no sex differences in applications for specialty training, but women had increased odds of getting an offer (OR=1.40; 95% CI=1.25 to 1.57; p<0.001) and accepting one (OR=1.43; 95% CI=1.19 to 1.71; p<0.001). Seven of the nine largest specialties showed significant sex differences in applications, which remained after adjusting for other factors. In the adjusted models, Paediatrics (OR=1.57; 95% CI=1.01 to 2.46; p=0.046) and general practice (GP) (OR=1.23; 95% CI=1.03 to 1.46; p=0.017) were the only specialties to show sex differences in offers, both favouring women. GP alone showed sex differences in acceptances, with women being more likely to accept (OR=1.34; 95% CI=1.03 to 1.76; p=0.03). Doctors with an FtP declaration were slightly less likely to apply to specialty training overall (OR=0.84; 95% CI=0.71 to 1.00; p=0.048) and less likely to accept an offer to any programme (OR=0.71; 95% CI=0.52 to 0.98; p=0.036), after adjusting for confounders. CONCLUSIONS Sex segregation between medical specialties is due to differential application, although research is needed to understand why men are less likely to be offered a place on to GP and Paediatrics training, and if offered GP are less likely to accept.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, University College London Medical School, London, UK
| | - Hirosha Jayaweera
- Research Department of Medical Education, University College London Medical School, London, UK
- Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Crawley, Western Australia, Australia
| | - Emily Unwin
- Research Department of Medical Education, University College London Medical School, London, UK
| | - Karim Keshwani
- Research Department of Medical Education, University College London Medical School, London, UK
- North Middlesex University Hospital NHS Trust, London, UK
| | - Christopher Valerio
- Research Department of Medical Education, University College London Medical School, London, UK
- North Middlesex University Hospital NHS Trust, London, UK
| | - Henry Potts
- Centre for Health Informatics and Multiprofessional Education, UCL, London, UK
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Wakeford R, Ludka K, Woolf K, McManus IC. Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study. BMC Med 2018; 16:230. [PMID: 30522486 PMCID: PMC6284295 DOI: 10.1186/s12916-018-1214-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/09/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK's General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance. METHODS Examination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n = 27,561) or Clinical Skills Assessment (CSA; n = 17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n = 37,358), Part 2 (MCQ; n = 28,285) or Practical Assessment of Clinical Examination Skills (PACES; n = 27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor's registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values. RESULTS Doctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen's d across the five exams of - 0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels. CONCLUSIONS MRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.
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Affiliation(s)
| | | | - Katherine Woolf
- Research Department of Medical Education, UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK
| | - I C McManus
- Research Department of Medical Education, UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK.
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Unwin E, Potts HWW, Dacre J, Elder A, Woolf K. Passing MRCP (UK) PACES: a cross-sectional study examining the performance of doctors by sex and country. BMC Med Educ 2018; 18:70. [PMID: 29625566 PMCID: PMC5889582 DOI: 10.1186/s12909-018-1178-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is much discussion about the sex differences that exist in medical education. Research from the United Kingdom (UK) and United States has found female doctors earn less, and are less likely to be senior authors on academic papers, but female doctors are also less likely to be sanctioned, and have been found to perform better academically and clinically. It is also known that international medical graduates tend to perform more poorly academically compared to home-trained graduates in the UK, US, and Canada. It is uncertain whether the magnitude and direction of sex differences in doctors' performance is variable by country. We explored the association between doctors' sex and their performance at a large international high-stakes clinical examination: the Membership of the Royal Colleges of Physicians (UK) Practical Assessment of Clinical Examination Skills (PACES). We examined how sex differences varied by the country in which the doctor received their primary medical qualification, the country in which they took the PACES examination, and by the country in which they are registered to practise. METHODS Seven thousand six hundred seventy-one doctors attempted PACES between October 2010 and May 2013. We analysed sex differences in first time pass rates, controlling for ethnicity, in three groups: (i) UK medical graduates (N = 3574); (ii) non-UK medical graduates registered with the UK medical regulator, the General Medical Council (GMC), and thus likely to be working in the UK (N = 1067); and (iii) non-UK medical graduates without GMC registration and so legally unable to work or train in the UK (N = 2179). RESULTS Female doctors were statistically significantly more likely to pass at their first attempt in all three groups, with the greatest sex effect seen in non-UK medical graduates without GMC registration (OR = 1.99; 95% CI = 1.65-2.39; P < 0.0001) and the smallest in the UK graduates (OR = 1.18; 95% CI = 1.03-1.35; P = 0.02). CONCLUSIONS As found in a previous format of this examination and in other clinical examinations, female doctors outperformed male doctors. Further work is required to explore why sex differences were greater in non-UK graduates, especially those without GMC registration, and to consider how examination performance may relate to performance in practice.
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Affiliation(s)
- Emily Unwin
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
| | - Henry W. W. Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Jane Dacre
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE UK
| | - Andrew Elder
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
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Abstract
OBJECTIVES To explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change. DESIGN Qualitative semistructured individual and group interview study. SETTING Postgraduate medical education in the UK. PARTICIPANTS Individuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers. RESULTS Representatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty. CONCLUSIONS Representatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic differences in attainment among UKGs); better sharing of information and resources nationally to empower organisations to effect change locally and within specialties; and evaluation of evidence-based interventions.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Hirosha Jayaweera
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
- Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Crawley, Western Australia, Australia
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
- Research Department of Medical Education, UCL Medical School, London, UK
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Yeates P, Woolf K, Benbow E, Davies B, Boohan M, Eva K. A randomised trial of the influence of racial stereotype bias on examiners' scores, feedback and recollections in undergraduate clinical exams. BMC Med 2017; 15:179. [PMID: 29065875 PMCID: PMC5655938 DOI: 10.1186/s12916-017-0943-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/11/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Asian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as "differential attainment"). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students' scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students' performance; whether activation depends on the stereotypicality of students' performances; and whether stereotypes influence examiner memories of performances. METHODS This is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students' performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos). RESULTS Examiners responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702-731 ms) faster than neutral words (769 ms, 95% CI 753-786 ms, p < 0.001), suggesting Asian stereotypes were activated (or at least active) in examiners' minds. This occurred regardless of whether examiners observed stereotype-consistent or stereotype-inconsistent performances. Despite this stereotype activation, student ethnicity had no influence on examiners' scores; on the feedback examiners gave; or on examiners' memories for one performance. CONCLUSIONS Examiner bias does not appear to explain the differential attainment of Asian students in UK medical schools. Efforts to ensure equality should focus on social, psychological and cultural factors that may disadvantage learning or performance in Asian and other minority ethnic students.
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Affiliation(s)
- Peter Yeates
- Medical Education Research, School of Medicine, David Weatherall Building, Keele University, Newcastle under Lyme, ST5 5BG, UK. .,Acute and Respiratory Medicine at Pennine Acute Hospitals NHS Trust, Bury, UK.
| | - Katherine Woolf
- University College London Medical School, University College London, London, UK
| | - Emyr Benbow
- Division of Medical Education, University of Manchester, Manchester, UK.,Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ben Davies
- North Devon Healthcare NHS Trust, Barnstaple, UK
| | - Mairhead Boohan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Kevin Eva
- Centre for Health Education Scholarship, Faculty of Health, University of British Columbia, Vancouver, Canada
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Shephard T, Ganguzza L, Flink L, Ngai C, Acosta V, Burdowski J, Shah B, Woolf K. Association Between Smoking Status and Diet Quality Among Patients Referred for Coronary Angiography in New York City. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gafson I, Currie J, O'Dwyer S, Woolf K, Griffin A. Attitudes towards attrition among UK trainees in obstetrics and gynaecology. Br J Hosp Med (Lond) 2017; 78:344-348. [DOI: 10.12968/hmed.2017.78.6.344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Irene Gafson
- Specialty Registrar in Obstetrics and Gynaecology and Medical Education Fellow, Research Department of Medical Education, UCL Medical School, London
| | - Jane Currie
- Specialty Registrar in Obstetrics and Gynaecology and Clinical Research Fellow, Institute for Women's Health, University College London, London
| | - Sabrina O'Dwyer
- Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, Imperial Healthcare NHS Trust, London W12 0HS
| | - Katherine Woolf
- Senior Lecturer and Deputy Lead for Research, Research Department of Medical Education, UCL Medical School, London
| | - Ann Griffin
- Director and Lead for Research, Research Department of Medical Education, UCL Medical School, London
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Griffin A, McKeown A, Viney R, Rich A, Welland T, Gafson I, Woolf K. Revalidation and quality assurance: the application of the MUSIQ framework in independent verification visits to healthcare organisations. BMJ Open 2017; 7:e014121. [PMID: 28196952 PMCID: PMC5318568 DOI: 10.1136/bmjopen-2016-014121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We present a national evaluation of the impact of independent verification visits (IVVs) performed by National Health Service (NHS) England as part of quality assuring medical revalidation. Organisational visits are central to NHS quality assurance. They are costly, yet little empirical research evidence exists concerning their impact, and what does exist is conflicting. SETTING The focus was on healthcare providers in the NHS (in secondary care) and private sector across England, who were designated bodies (DBs). DBs are healthcare organisations that have a statutory responsibility, via the lead clinician, the responsible officer (RO), to implement medical revalidation. PARTICIPANTS All ROs who had undergone an IVV in England in 2014 and 2015 were invited to participate. 46 ROs were interviewed. Ethnographic data were gathered at 18 observations of the IVVs and 20 IVV post visit reports underwent documentary analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were the findings pertaining to the effectiveness of the IVV system in supporting the revalidation processes at the DBs. Secondary outcomes were methodological, relating to the Model for Understanding Success in Quality (MUSIQ) and how its application to the IVV reveals the relevance of contextual factors described in the model. RESULTS The impact of the IVVs varied by DB according to three major themes: the personal context of the RO; the organisational context of the DB; and the visit and its impact. ROs were largely satisfied with visits which raised the status of appraisal within their organisations. Inadequate or untimely feedback was associated with dissatisfaction. CONCLUSIONS Influencing teams whose prime responsibility is establishing processes and evaluating progress was crucial for internal quality improvement. Visits acted as a nudge, generating internal quality review, which was reinforced by visit teams with relevant expertise. Diverse team membership, knowledge transfer and timely feedback made visits more impactful.
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Affiliation(s)
- Ann Griffin
- Research Department for Medical Education, UCL Medical School, London, UK
| | - Alex McKeown
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Trevor Welland
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Irene Gafson
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
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Viney R, Rich A, Needleman S, Griffin A, Woolf K. The validity of the Annual Review of Competence Progression: a qualitative interview study of the perceptions of junior doctors and their trainers. J R Soc Med 2017; 110:110-117. [PMID: 28116956 DOI: 10.1177/0141076817690713] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
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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Affiliation(s)
- Rowena Viney
- 1 Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Antonia Rich
- 1 Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Sarah Needleman
- 2 St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Ann Griffin
- 1 Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Katherine Woolf
- 1 Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
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Isba R, Woolf K, Hanneman R. Social network analysis in medical education. Med Educ 2017; 51:81-88. [PMID: 27807877 DOI: 10.1111/medu.13152] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/25/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
CONTENT Humans are fundamentally social beings. The social systems within which we live our lives (families, schools, workplaces, professions, friendship groups) have a significant influence on our health, success and well-being. These groups can be characterised as networks and analysed using social network analysis. SOCIAL NETWORK ANALYSIS Social network analysis is a mainly quantitative method for analysing how relationships between individuals form and affect those individuals, but also how individual relationships build up into wider social structures that influence outcomes at a group level. Recent increases in computational power have increased the accessibility of social network analysis methods for application to medical education research. APPLICATION TO MEDICAL EDUCATION Social network analysis has been used to explore team-working, social influences on attitudes and behaviours, the influence of social position on individual success, and the relationship between social cohesion and power. This makes social network analysis theories and methods relevant to understanding the social processes underlying academic performance, workplace learning and policy-making and implementation in medical education contexts. CONCLUSIONS Social network analysis is underused in medical education, yet it is a method that could yield significant insights that would improve experiences and outcomes for medical trainees and educators, and ultimately for patients.
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Affiliation(s)
- Rachel Isba
- Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Robert Hanneman
- Department of Sociology, University of California, Riverside, California, USA
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Abstract
OBJECTIVES Investigate the work-life balance of doctors in training in the UK from the perspectives of trainers and trainees. DESIGN Qualitative semistructured focus groups and interviews with trainees and trainers. SETTING Postgraduate medical training in London, Yorkshire and Humber, Kent, Surrey and Sussex, and Wales during the junior doctor contract dispute at the end of 2015. Part of a larger General Medical Council study about the fairness of postgraduate medical training. PARTICIPANTS 96 trainees and 41 trainers. Trainees comprised UK graduates and International Medical Graduates, across all stages of training in 6 specialties (General Practice, Medicine, Obstetrics and Gynaecology, Psychiatry, Radiology, Surgery) and Foundation. RESULTS Postgraduate training was characterised by work-life imbalance. Long hours at work were typically supplemented with revision and completion of the e-portfolio. Trainees regularly moved workplaces which could disrupt their personal lives and sometimes led to separation from friends and family. This made it challenging to cope with personal pressures, the stresses of which could then impinge on learning and training, while also leaving trainees with a lack of social support outside work to buffer against the considerable stresses of training. Low morale and harm to well-being resulted in some trainees feeling dehumanised. Work-life imbalance was particularly severe for those with children and especially women who faced a lack of less-than-full-time positions and discriminatory attitudes. Female trainees frequently talked about having to choose a specialty they felt was more conducive to a work-life balance such as General Practice. The proposed junior doctor contract was felt to exacerbate existing problems. CONCLUSIONS A lack of work-life balance in postgraduate medical training negatively impacted on trainees' learning and well-being. Women with children were particularly affected, suggesting this group would benefit the greatest from changes to improve the work-life balance of trainees.
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Affiliation(s)
- Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Sarah Needleman
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London, UK
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Abstract
OBJECTIVES Explore trainee doctors' experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification. DESIGN Qualitative semistructured focus group and interview study. SETTING Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales. PARTICIPANTS 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad. RESULTS Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work-life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising. CONCLUSIONS BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on trainee-trainer relationships at work and organisational changes to improve trainees' ability to seek social support outside work.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Sarah Needleman
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, London, UK
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McConnell C, McPherson A, Woolf K. Diet Quality among Marching Artists at Different Competition Levels and Captions. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Burris J, Rietkerk W, Shikany J, Woolf K. A Low Glycemic Load Diet Improves the Hormonal Response Associated with Acne in a Cohort of Adults with Moderate and Severe Acne. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Unwin E, Woolf K, Wadlow C, Potts HWW, Dacre J. Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. BMC Med 2015; 13:172. [PMID: 26268807 PMCID: PMC4535538 DOI: 10.1186/s12916-015-0413-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time. METHODS The electronic databases MEDLINE, EMBASE, and PsycINFO were searched from inception to January 2015. Backward and forward citation searching was performed. Journals that yielded the majority of the eligible articles and journals in the medical education field were electronically searched, along with the conference and poster abstracts from two of the largest international medical education conferences. Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors' sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation. RESULTS Overall, 32 reports examining the association between doctors' sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses. CONCLUSION Male doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time.
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Affiliation(s)
- Emily Unwin
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Katherine Woolf
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Clare Wadlow
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Henry W W Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
| | - Jane Dacre
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE, UK.
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Affiliation(s)
- Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - Lynn Monrouxe
- Institute of Medical Education, Cardiff University, UK
| | - Jan Illing
- Centre for Medical Education Research, University of Durham, UK
| | - Alison Bullock
- Cardiff Unit for Research in Medical and Dental Education, Cardiff University, UK
| | - Trudie Roberts
- Leeds Institute of Medical Education, University of Leeds, UK
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