How might the rapid development of artificial intelligence affect the delivery of UK Defence healthcare?

Artificial intelligence (AI) has developed greatly and is now at the centre of technological advancements. Current and recent military conflicts have highlighted the evolving complexity of warfare with rapid technological change at the heart of it. AI aims to understand and design systems that show signs of intelligence and are able to learn by deriving knowledge from data. There have been multiple AI-related developments in the medical field in areas such as diagnostics, triage, wearable technology and training with direct translations that may benefit UK Defence healthcare. With the increasing use of AI in society and medical practice, it is important to consider whether AI can be trustworthy and has any legal implications, and evaluate its use through an ethical lens. In conclusion, the rapid development of AI presents exciting opportunities for UK Defence to enhance its healthcare delivery. This paper was selected as the BMJ Military Health Essay Prize winner at the Royal Society of Medicine Colt Foundation Meeting 2023.

Do medical specialists accept claims-based Audit and Feedback for quality improvement? A focus group study

OBJECTIVES

Audit and Feedback (A&F) is a widely used quality improvement (QI) intervention in healthcare. However, not all feedback is accepted by professionals. While claims-based feedback has been previously used for A&F interventions, its acceptance by medical specialists is largely unknown. This study examined medical specialists' acceptance of claims-based A&F for QI.

DESIGN

Qualitative design, with focus group discussions. Transcripts were analysed using discourse analysis.

SETTING AND PARTICIPANTS

A total of five online focus group discussions were conducted between April 2021 and September 2022 with 21 medical specialists from varying specialties (urology; paediatric surgery; gynaecology; vascular surgery; orthopaedics and trauma surgery) working in academic or regional hospitals in the Netherlands.

RESULTS

Participants described mixed views on using claims-based A&F for QI. Arguments mentioned in favour were (1) A&F stimulates reflective learning and improvement and (2) claims-based A&F is more reliable than other A&F. Arguments in opposition were that (1) A&F is insufficient to create behavioural change; (2) A&F lacks clinically meaningful interpretation; (3) claims data are invalid for feedback on QI; (4) claims-based A&F is unreliable and (5) A&F may be misused by health insurers. Furthermore, participants described several conditions for the implementation of A&F which shape their acceptance.

CONCLUSIONS

Using claims-based A&F for QI is, for some clinical topics and under certain conditions, accepted by medical specialists. Acceptance of claims-based A&F can be shaped by how A&F is implemented into clinical practice. When designing A&F for QI, it should be considered whether claims data, as the most resource-efficient data source, can be used or whether it is necessary to collect more specific data.

Educommunication in nutrition and neurodegenerative diseases: a scoping review protocol

INTRODUCTION

Neurodegenerative diseases affect the nervous system and are characterised by the deterioration and/or death of neurons. Nutrition care is essential for maintaining an adequate nutritional status, which influences the prognosis and survival of patients with neurological diseases. Caregivers participate assiduously in the care of these patients and must be integrated into the multidisciplinary team. They often need specific training or knowledge regarding food and nutrition to perform their roles with patients. Health educommunication is a learning tool that can positively influence the appropriation of the theme and the construction of care autonomy. This scoping review (ScR) will map educommunication actions/strategies in nutrition and neurodegenerative diseases.

METHODS AND ANALYSIS

This ScR will be designed based on the methodology of Arksey and O'Malley and will follow the methodological guidance for conducting a Joanna Briggs Institute ScR. The research question addressed by the scoping review will be: what actions/strategies for educommunication in nutrition and neurodegenerative diseases have been developed for patients or caregivers? Many search sites it will be used in this review, such as electronic databases (Embase, PubMed/MEDLINE, Scopus, Web of Science), Google Scholar and grey literature sources. No restrictions of date or language will be applied to the search strategy. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Data, including the study design, objective, study population, neurodegenerative diseases, nutrition topics and educommunication strategies will be logically organised and tabulated in Microsoft Excel.

ETHICS AND DISSEMINATION

The data used for this review are from secondary sources and available to the public; thus, no ethical approval and human consent will be required for this study. Dissemination of the results will be published in a peer-reviewed journal and presented at conferences.

Qualitative investigation of military surgical resuscitation teams: what are the drivers of success of a rapid response team?

OBJECTIVES

This qualitative study explores the characteristics of a specialised military medical rapid response team (MRRT), the surgical resuscitation team (SRT). Despite mixed evidence of efficacy, civilian MRRTs are widely employed, with significant variation in structure and function. Recent increased use of these teams to mitigate patient risk in challenging healthcare scenarios, such as global pandemics, mass casualty events and resource-constrained health systems, mandates a reconceptualisation of how civilian MRRTs are created, trained and used. Here, we study the core functions and foundational underpinnings of SRTs and discuss how civilian MRRTs might learn from their military counterparts.

DESIGN

Semistructured interview-based study using Descriptive Qualitative Research methodology and Thematic Analysis.

SETTING

Remote audio interviews conducted via Zoom.

PARTICIPANTS

Participants included 15 members of the United States Special Operations Command SRTs, representing all medical specialties of the SRT as well as operational planners.

RESULTS

Adaptability was identified as a core function of SRTs and informed by four foundational underpinnings: mission variability, shared values and principles, interpersonal and organisational trust and highly effective teaming. Our findings provide three important insights for civilian MRRTs: (1) team member roles should not be defined by silos of professional specialisation, (2) trust is a key factor in the teaming process and (3) team principles and values result in and are reinforced by organisational trust.

CONCLUSION

This study offers the first in-depth investigation of a unique military MRRT. Important insights that may offer benefit to civilian MRRT practices include enabling the breakdown of traditional division of labour, allowing for and promoting deep interpersonal and professional familiarity, and facilitating a cycle of positive reinforcement between teams and organisations. Future investigation of small team limitations, comparability to civilian MRRTs, and the team relationship to the larger organisation are needed to better understand how these teams function in a healthcare system and translate to civilian practice.

Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement

INTRODUCTION

Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain.

METHODS AND ANALYSIS

A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews.

ETHICS APPROVAL AND DISSEMINATION

Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country.

TRIAL REGISTRATION NUMBER

ISRCTN18010240.

Experiences of the clinical academic pathway: a qualitative study in Greater Manchester to improve the opportunities of minoritised clinical academics

OBJECTIVES

The aim of this study was to explore the barriers and facilitators faced by clinical academics (CAs) in the Greater Manchester region, with particular attention to the experiences of minoritised groups.

DESIGN

A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was applied to identify key themes.

SETTING

University of Manchester and National Health Service Trusts in the Greater Manchester region.

PARTICIPANTS

The sample of this study was composed of 43 participants, including CAs, senior stakeholders, clinicians and medical and dental students.

RESULTS

Six themes were identified. CAs face several barriers and facilitators, some of which-(1) funding insecurity and (2) high workload between the clinic and academia-are common to all the CAs. Other barriers, including (3) discrimination that translates into struggles with self-worth and feeling of not belonging, (4) being or being perceived as foreign and (5) unequal distribution of care duties, particularly affect people from minoritised groups. In contrast, (6) mentorship was commonly identified as one of the most important facilitators.

CONCLUSIONS

Cultural and structural interventions are needed, such as introducing financial support for early career CAs and intercalating healthcare students to promote wider social and cultural change and increase the feelings of belonging and representation across the entire CA pipeline.

Can ChatGPT pass the MRCP (UK) written examinations? Analysis of performance and errors using a clinical decision-reasoning framework

OBJECTIVE

Large language models (LLMs) such as ChatGPT are being developed for use in research, medical education and clinical decision systems. However, as their usage increases, LLMs face ongoing regulatory concerns. This study aims to analyse ChatGPT's performance on a postgraduate examination to identify areas of strength and weakness, which may provide further insight into their role in healthcare.

DESIGN

We evaluated the performance of ChatGPT 4 (24 May 2023 version) on official MRCP (Membership of the Royal College of Physicians) parts 1 and 2 written examination practice questions. Statistical analysis was performed using Python. Spearman rank correlation assessed the relationship between the probability of correctly answering a question and two variables: question difficulty and question length. Incorrectly answered questions were analysed further using a clinical reasoning framework to assess the errors made.

SETTING

Online using ChatGPT web interface.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the score (percentage questions correct) in the MRCP postgraduate written examinations. Secondary outcomes were qualitative categorisation of errors using a clinical decision-making framework.

RESULTS

ChatGPT achieved accuracy rates of 86.3% (part 1) and 70.3% (part 2). Weak but significant correlations were found between ChatGPT's accuracy and both just-passing rates in part 2 (r=0.34, p=0.0001) and question length in part 1 (r=-0.19, p=0.008). Eight types of error were identified, with the most frequent being factual errors, context errors and omission errors.

CONCLUSION

ChatGPT performance greatly exceeded the passing mark for both exams. Multiple choice examinations provide a benchmark for LLM performance which is comparable to human demonstrations of knowledge, while also highlighting the errors LLMs make. Understanding the reasons behind ChatGPT's errors allows us to develop strategies to prevent them in medical devices that incorporate LLM technology.

How to facilitate NHS professionals to recognise and use skills gained from global health engagement when back in the UK workforce? A participatory action research project to design, pilot and evaluate a series of online leadership workshops

OBJECTIVES

Leadership knowledge and skills are known to be developed by health professionals during global health experiences overseas. However, volunteers struggle to recognise and use these new skills on return to their workplace. A series of bespoke leadership workshops were designed, delivered and evaluated by leadership experts to help enhance the transferability of leadership skills back to the UK National Health Service.

DESIGN

A mixed-methods participatory action research methodology was employed to explore the impact of the workshops. This approach lends itself to a complex, situated project involving multiple partners. Quantitative and qualitative descriptive data were collected via online survey (n=29 participants) and focus groups (n=18 focus groups) and thematically analysed.

SETTING

The authors delivered the tailored leadership workshops online to globally engaged National Health Service (NHS) healthcare professionals based in England who had all worked overseas within the past 5 years.

PARTICIPANTS

29 participants attended: 11 medical doctors; 6 nurses/midwives; 10 allied health professionals; 1 NHS manager and 1 student nurse (who was also working as a healthcare assistant).

RESULTS

Participants were able to network both during the large group discussions and while in smaller breakout groups. Data highlighted the substantial benefits obtained from this networking, with 91% of participants reporting it enriched their learning experience, particularly within a multi-disciplinary context, and by having the time and space for facilitated reflection on leadership. Furthermore, 78% agreed that they learned new skills for influencing change beyond their position and 76% reported they could maximise the impact of this change for themselves and their employer. Participants also reported the development of systems and ethical leadership knowledge that they felt they could transfer to their NHS roles.

CONCLUSIONS

This study extends explorations of global health experiences by moving beyond the skills gained while working in low-income and middle-income countries. The innovative online leadership workshops gave agency to individuals to recognise and use the skills gained from global health placements on return to the NHS.

UK medical students' self-reported knowledge and harm assessment of psychedelics and their application in clinical research: a cross-sectional study

OBJECTIVE

To capture UK medical students' self-reported knowledge and harm assessment of psychedelics and to explore the factors associated with support for changing the legal status of psychedelics to facilitate further clinical research.

DESIGN

Cross-sectional, anonymous online survey of UK medical students using a non-random sampling method.

SETTING

UK medical schools recognised by the General Medical Council.

PARTICIPANTS

132 medical students who had spent an average of 3.8 years (SD=1.4; range: 1-6) in medical school.

RESULTS

Most students (83%) reported that they were aware of psychedelic research and only four participants (3%) said that they were not interested in learning more about this type of research. Although medical students' harm assessment of psychedelics closely aligned with that of experts, only 17% of students felt well-educated on psychedelic research. Teachings on psychedelics were only rarely encountered in their curriculum (psilocybin: 14.1 (SD=19.9), scale: 0 (never) to 100 (very often)). Time spent at medical schools was not associated with more knowledge about psychedelics (r=0.12, p=0.129). On average, this sample of medical students showed strong support for changing the legal status of psychedelics to facilitate further research into their potential clinical applications (psilocybin: 80.2 (SD=24.8), scale: 0 (strongly oppose) to 100 (strongly support)). Regression modelling indicated that greater knowledge of psychedelics (p<0.001), lower estimated harm scores (p<0.001), more time spent in medical school (p=0.024) and lower perceived effectiveness of non-pharmacological mental health treatments (p=0.044) were associated with greater support for legal status change.

CONCLUSIONS

Our findings reveal a significant interest among UK medical students to learn more about psychedelic research and a strong support for further psychedelic research. Future studies are needed to examine how medical education could be refined to adequately prepare medical students for a changing healthcare landscape in which psychedelic-assisted therapy could soon be implemented in clinical practice.

What works for whom, how and why in mental health education for undergraduate health profession students? A realist synthesis protocol

INTRODUCTION

It has been shown that mental health education can support positive attitudes of health profession students towards people with mental health challenges, which supports them to provide optimal healthcare to this group. There are many different approaches to designing and delivering mental health education to health profession students. Each has their own advantages and disadvantages, and often mental health education programmes incorporate a multimodal approach in order to reap the benefits of a variety of teaching and learning approaches. The aim of this study is to understand the current landscape of teaching and learning approaches to mental health education for undergraduate health profession students. We will examine the features of successful outcomes for health profession students for:Learning environment.Knowledge development and retention.Confidence.

MOTIVATION

Preparedness for professional practice.

METHODS

For this, a realist synthesis has been chosen in order to review the literature. Realist synthesis lends itself to the review of complex interventions such as mental health education for undergraduate health profession curricula because it seeks to uncover the range of different mechanisms and context configurations that produce different outcomes. Health profession education and education practice, in general, is complex. A patient and public involvement (PPI) group is involved throughout this study and includes undergraduate health profession students, and members of the St John of Gods Hospital Consumers and Carers Council who are involved at every stage of the research. This study will engage with a stakeholder group who will support the refining of the programme theory.

ETHICS AND DISSEMINATION

Ethical approval has been sought and approved by Royal College of Surgeons, Ireland Ethical Committee (REC number: 212622783). We will aim to write up and publish the full synthesis as a journal article. We will also discuss ways of dissemination outside of academia with our PPI group.

Changes in medical student attendance and its impact on student educational outcomes: a systematic review protocol

INTRODUCTION

The COVID-19 pandemic has had a significant impact on medical education, with many institutions shifting to online learning to ensure the safety of students and staff. However, there has been a decline in in-person attendance at medical schools across the UK and worldwide following the relaxation of social distancing rules and the reinstation of in-person teaching. Importantly, this trend has been observed prior to the pandemic. While reflected within the literature, there is currently no systematic review describing these changes. We aim to find out how medical students' attendance is changing as documented within the literature and its impact on their educational outcomes.

METHODS AND ANALYSIS

This systematic review will follow the guidelines of the Centre of Research and Dissemination, Meta-analyses of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We will search the major databases of Medline via Ovid, Embase via Ovid, Scopus, Web of Science, British Education Index via EBSCOhost and ERIC via EBSCOhost.Two reviewers will independently screen each paper and extract data, with a third reviewer for dispute resolution. All studies reporting on medical students from various universities, both graduate and undergraduate and describing changes in attendance and/or students' educational outcomes will be included. Risk of bias in individual studies will be assessed using the Newcastle-Ottawa Scale and confidence in cumulative evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach. A narrative synthesis of the findings from all included studies will be reported.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review of existing publicly available literature. We will subsequently aim to publish the results of this systematic review in a peer-reviewed journal.

Impact of the economic crisis, COVID-19 and the Beirut explosion on ophthalmology training in Lebanon: an observational cohort survey-based study

OBJECTIVES

The objective of the study is to investigate the effects of the COVID-19 pandemic, the economic crisis and the Beirut explosion on the training and work of ophthalmology residents and faculty in Lebanon.

DESIGN

This is an observational cohort survey-based research conducted between January and December 2022.

SETTING

The study targeted all ophthalmology residents and core faculty in Lebanon.

PARTICIPANTS

A total of 52 participants, including 27 residents and 25 core faculty members, completed the survey.

PRIMARY OUTCOME MEASURE

Primary outcomes comprised the subjectively reported effect of the three major external stressors on the training and well-being of ophthalmology trainees and educators in Lebanon.

RESULTS

The study found that the majority of ophthalmology residents and core faculty members were significantly affected by the COVID-19 pandemic, Beirut explosion and the economic crisis in Lebanon. Significant percentage reported financial burden, decrease in outpatient and surgical load and educational activities. Furthermore, most participants reported higher levels of stress, anxiety and depression during the time of crises.

CONCLUSIONS

This study emphasises the need to support healthcare professionals during times of crisis, as they are on the frontlines and can experience high levels of stress, anxiety and depression. By providing support and resources to healthcare professionals, they can better cope with the challenges they face and continue to provide essential care to their patients.

University staff perspectives on determinants of high-quality health professions student placements in regional, rural and remote Australia: protocol for a mixed-method study

INTRODUCTION

In rural areas, work-integrated learning in the form of health student placements has several potential benefits, including contributing to student learning, enhancing rural health service capacity and attracting future rural health workforce. Understanding what constitutes a high-quality rural placement experience is important for enhancing these outcomes. There is no current standardised definition of quality in the context of rural health placements, nor is there understanding of how this can be achieved across different rural contexts. This study is guided by one broad research question: what do university staff believe are the determinants of high-quality health professions student placements in regional, rural and remote Australia?

METHODS AND ANALYSIS

This study will adopt a convergent mixed-method design with two components. Component A will use explanatory sequential mixed methods. The first phase of component A will use a survey to explore determinants that contribute to the development of high-quality health student placements from the perspective of university staff who are not employed in University Departments of Rural Health and are involved in the delivery of health student education. The second phase will use semistructured interviews with the same stakeholder group (non-University Department of Rural Health university staff) to identify the determinants of high-quality health student placements. Component B will use a case study Employing COnceptUal schema for policy and Translation Engagement in Research mind mapping method to capture determinants that contribute to the development of high-quality health student placements from the perspective of University Department of Rural Health university staff.

ETHICS AND DISSEMINATION

The University of Melbourne Human Ethics Committee approved the study (2022-23201-33373-5). Following this, seven other Australian university human research ethics committees provided external approval to conduct the study. The results of the study will be presented in several peer-review publications and summary reports to key stakeholder groups.

The Defence General Practitioner: an Updated Definition and Model

The geopolitical setting has changed significantly since the definition of UK Armed Forces General Practice was published in 2012. New operating models require medical services to provide smaller teams operating at greater reach from secondary care and logistical support. The Defence Medical Services have reorganised to meet these changing needs. Defence general practices (DGPs) are key enablers of the Defence strategic effort, both integral to deployed units, in preparing forces for deployment and managing their rehabilitation back to fitness. A formal role performance statement (RPS) has been created to guide the training and development of DGPs to meet these changing requirements. The RPS details the additional scope of practice, beyond the national GP licensing standard, in which DGPs work. In this article, we compare and contrast the RPS with the previous definition of a DGP. The resultant updated model recharacterises the extended roles into five themes of DGP built on the foundation of the Royal College of General Practitioners curriculum. This new model provides the platform on which to develop the clinical specialty over the next decade and highlights avenues for educational interventions to develop future generations of DGPs.

Impact of involvement in mental health professional education on patient educators: a qualitative systematic review

OBJECTIVES

Patient involvement in mental health professional education is required by policy but lacks a robust evidence base. The impact of involvement in education on patients with mental health conditions may differ from that of patients with other conditions. This study aims to review the impact of involvement in mental health professional education on the patients with mental health conditions involved.

SETTING

Electronic databases MEDLINE, PubMed, AMED, EMBASE, PsycINFO, Emcare, BNI, HMIC and CINAHL were systematically searched to find articles reporting on health professional teaching interventions involving patients with mental health conditions and the psychological, social or physical impact of involvement. The search took place in August 2023.

RESULTS

Findings from 20 articles were amalgamated into four synthesised findings: (1) Impact of general involvement (2) impact of making a difference through teaching, (3) impact of new relationships and (4) impact of talking about experiences.

CONCLUSIONS

Patient involvement in mental health professional education can be beneficial for patients with mental health conditions when their experiences are respected and valued as expertise by students and academic staff. The experiences of patient educators in the mental health field are unique in that teaching activities interact with their mental health. Future research should evaluate patient involvement in the mental health field separately and report research findings according to reporting guidelines.

PROSPERO REGISTRATION NUMBER

CRD42020224907.

Qualitative study investigating the professional and personal effects of patient suicide on general practitioners in Northern Ireland

OBJECTIVE

There is a dearth in suicide literature addressing the impact on general practitioners (GPs) of losing a patient. We aimed to examine the personal and professional impact as well as the availability of support and why GPs did or did not use it.

DESIGN

A qualitative study using one-to-one interviews with participants recruited using snowball sampling.

SETTING

The study was conducted in a primary care setting.

PARTICIPANTS

Interviews were held with 19 GPs within primary care in Northern Ireland.

RESULTS

GPs are impacted both personally and professionally when they lose a patient to suicide, but may not access formal help due to commonly held idealised notions of a 'good' GP who is regarded as having solid imperturbability. Fear of professional repercussions also plays a major role in deterring help-seeking.

CONCLUSIONS

There is a need for a systemic culture shift within general practice which allows doctors to seek support when their physical or mental health require it. This may help prevent stress, burnout and early retirement.

Sustained benefits of a generalist training programme for UK doctors: a survey-based follow-up study

OBJECTIVES

The study aimed to conduct a follow-up of all broad-based training (BBT) trainees who participated in the original evaluation completed in 2017. The follow-up study explored the impact of BBT on career decisions, sustained benefits and unintended disadvantages of the programme, and views on the future of training.

DESIGN

Scoping interviews informed the design of an online survey. The interview transcripts were analysed thematically. The survey was piloted with six volunteers and sent out to all former BBT trainees. Data from the survey were transferred to Excel and SPSS for analysis. The open-text comments on the survey were subject to a thematic content analysis.

SETTING

Participants were working in general practice, paediatrics, psychiatry or medicine.

PARTICIPANTS

Eight former BBT trainees participated in the scoping interviews. Interview participants were selected to ensure a diversity of current specialties and to represent all three BBT cohorts. All former BBT trainees were invited to complete the survey (n=118) and 70 replied.

RESULTS

The benefits of BBT were sustained over time: participants were confident in their career decisions, took a holistic approach to care and capitalised on their experiences in other specialties in their current roles. A minority of trainees also experienced temporary challenges when they joined a specialty training programme after completing the BBT. Whatever their specialty, experience in core medicine, paediatrics, psychiatry and general practice was valued. Disadvantages were short-lived (catching up on transition specialty training) or affected a minority (impact on sense of belonging).

CONCLUSIONS

The BBT programme supported the development of generalist doctors. Greater attention needs to be given to training secondary care doctors who take a holistic view of the patient and navigate their specialist care.

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

INTRODUCTION

To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.

METHODS

6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.

RESULTS

aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1-9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%-63%), unconscious-incompetence 32% (IQR: 23%-42%), conscious-incompetence 7% (IQR: 2%-15%), and unconscious-competence 2% (IQR: 0%-3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.

CONCLUSION

aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.

Exploring the value of structured narrative feedback within the Serious Illness Conversation-Evaluation Exercise (SIC-Ex): a qualitative analysis

OBJECTIVES

The Serious Illness Conversation Guide (SICG) has emerged as a framework for conversations with patients with a serious illness diagnosis. This study reports on narratives generated from open-ended questions of a novel assessment tool, the Serious Illness Conversation-Evaluation Exercise (SIC-Ex), to assess resident-led conversations with patients in oncology outpatient clinics.

DESIGN

Qualitative study using template analysis.

SETTING

Three academic cancer centres in Canada.

PARTICIPANTS

7 resident physicians (trainees), 7 patients from outpatient cancer clinics, 10 preceptors (raters) consisting of medical oncologists, palliative care physicians and radiation oncologists.

INTERVENTIONS

Each trainee conducted an SIC with a patient, which was videotaped. The raters watched the videos and evaluated each trainee using the novel SIC-Ex and the reference Calgary-Cambridge Guide (CCG) initially and again 3 months later. Two independent coders used template analysis to code the raters' narrative comments and identify themes/subthemes.

OUTCOME MEASURES

How narrative comments aligned with elements of the CCG and SICG.

RESULTS

Template analysis yielded four themes: adhering to SICG, engaging patients and family members, conversation management and being mindful of demeanour. Narrative comments identified numerous verbal and non-verbal elements essential to SICG. Some comments addressing general skills in engaging patients/families and managing the conversation (eg, setting agenda, introduction, planning, exploring, non-verbal communication) related to both the CCG and SICG, whereas other comments such as identifying substitute decision maker(s), affirming commitment and introducing Advance Care Planning were specific to the SICG.

CONCLUSIONS

Narrative comments generated by SIC-Ex provided detailed and nuanced insights into trainees' competence in SIC, beyond the numerical ratings of SIC-Ex and the general communication skills outlined in the CCG, and may contribute to a more fulsome assessment of SIC skills.

Followership: an undervalued concept in effective teams within the military and NHS

INTRODUCTION

Leadership is accepted as a crucial component of effective working within teams. Followership's contribution to successful performance is increasingly recognised but understudied. This study evaluated followership levels in military doctors at different stages of their careers and made recommendations for how followership concepts can be used to develop the self and better understand the challenges of small team working.

METHODS

A self-report study in which Kelley's followership questionnaire was distributed to 64 military doctors in three cohorts. 53 results were assessed using Kelley's followership framework. Subgroup analysis was undertaken to look at differences depending on service, age, gender and career stage.

RESULTS

The study demonstrated a predominant exemplary followership style within military doctors. No statistical difference was identified at the 0.05 level in followership by career stage, age, gender or service in the sample group.

CONCLUSION

This study gives insight into the attributes of doctors within the Defence Medical Services and laid out a methodology for further cohort evaluations of followership. It made recommendations on the areas of the field that require further research and how followership concepts may be included in further development courses and reporting for military medical personnel.

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

INTRODUCTION

Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes.

METHODS AND ANALYSIS

The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested.

ETHICS AND DISSEMINATION

The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05343390.

Taxonomy of teaching methods and their use in health professions education: a scoping review protocol

INTRODUCTION

Applying the lens of social constructivist theory, teaching methods facilitate the process of learning and may be used differently across settings to align learning goals. Teaching methods are used across disciplines, occupations and learning settings, yet terminology, descriptions and application for use vary widely. This scoping review will identify eligible literature of reported teaching methods with documented descriptions across disciplines with a focus of how teaching methods are applied to health professions education. A literary description of a teaching method was used as a basis from which to select eligible articles based on two criteria, a specified method and delivery of that teaching by a teacher figure.

METHODS AND ANALYSIS

Using the extension of the Joanna Briggs Institute methodology aligned to Arksey and O'Malley's six-stage framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, this scoping review will systematically search ERIC, Embase, Web of Science and PubMed databases. The search strategy was supported by an information specialist. Eligible studies will be identified in a two-stage screening process with four researchers. To complement eligible peer-reviewed literature, we will also search out relevant grey literature including University Websites, Conference Programmes and handsearched reference lists. Data extraction will be performed using a developed data extraction tool. A narrative summary will accompany charted results and describe the results aligned to the study objectives.

ETHICS AND DISSEMINATION

As no intervention or patient recruitment is required for this research, ethics board approval is not required. Results will be disseminated via publication in a peer-reviewed journal, conference presentations and where feasible reaching out to those organisations and universities with published glossaries of terms for teaching.

Effectiveness of patients' involvement in a medical and nursing pain education programme: a protocol for an open-label randomised controlled trial including qualitative data

INTRODUCTION

Pain is a multidimensional experience that varies among individuals and has a significant impact on their health. A biopsychosocial approach is recommended for effective pain management; however, health professionals' education is weak on this issue. Patient involvement is a promising didactic methodology in developing a more holistic perspective, however there is a lack of reliable evidence on this topic. The aim of the present study is to evaluate the effectiveness of patient involvement in pain education in undergraduate medicine and nursing students.

METHODS AND ANALYSIS

An open-label randomised controlled trial including qualitative data will be conducted. After an introductory lesson, each student will be randomly assigned to the intervention group, which includes an educational session conducted by a patient-partner along with an educator, or to the control group in which the session is exclusively conducted by an educator. Both sessions will be carried out according to the Case-Based Learning approach. Primary outcomes will be students' knowledge, attitudes, opinions and beliefs about pain management, whereas the secondary outcome will be students' satisfaction. The Pain Knowledge and Attitudes (PAK) and Chronic Pain Myth Scale (CPMS) will be administered preintervention and postintervention to measure primary outcomes. Students' satisfaction will be measured by a questionnaire at the end of the session. Two focus groups will be conducted to evaluate non-quantifiable aspects of learning.

ETHICS AND DISSEMINATION

The protocol of this study was approved by the independent Area Vasta Emilia Nord ethics committee.Adherence to The Declaration of Helsinki and Good Clinical Practice will ensure that the rights, safety and well-being of the participants in the study are safeguarded, as well as data reliability. The results will be disseminated through scientific publications and used to improve the educational offer. A version of the anonymised data set will be released for public access.

TRIAL REGISTRATION

Trial was not registered on ClinicalTrials.gov as the interventions being compared only concern educational programmes and the outcomes considered do not refer to any clinical dimension.

How do field epidemiologists learn? A protocol for a qualitative inquiry into learning in field epidemiology training programmes

INTRODUCTION

COVID-19 underscored the importance of field epidemiology training programmes (FETPs) as countries struggled with overwhelming demands. Experts are calling for more field epidemiologists with better training. Since 1951, FETPs have been building public health capacities across the globe, yet explorations of learning in these programmes are lacking. This qualitative study will (1) describe approaches to training field epidemiologists in FETP; (2) describe strategies for learning field epidemiology among FETP trainees and (3) explain the principles and practices aligning training approaches with learning strategies in FETP.

METHODS AND ANALYSIS

The research design, implementation and interpretation are collaborative efforts with FETP trainers. Data collection will include interviews with FETP trainers and trainees and participant observations of FETP training and learning events in four FETP in the Western Pacific Region. Data analysis will occur in three phases: (1) we will use the constant comparison method of Charmaz's grounded theory during open coding to identify and prioritise categories and properties in the data; (2) during focused coding, we will use constant comparison and Polkinghorne's analysis of narratives, comparing stories of prioritised categories, to fill out properties of those categories and (3) we will use Polkinghorne's narrative analysis to construct narratives that reflect domains of interest, identifying correspondence among Carr and Kemmis's practices, understandings and situations to explain principles and processes of learning in FETP.

ETHICS AND DISSEMINATION

We have obtained the required ethics approvals to conduct this research at The Australian National University (2021/771) and Taiwan's Ministry of Health and Welfare (112206). Data will not be available publicly, but anonymised findings will be shared with FETP for collaborative interpretation. Ultimately, findings and interpretations will appear in peer-reviewed journals and conferences.

Attitude toward career development in Japanese medical students: a questionnaire survey

OBJECTIVES

The study aimed to evaluate attitudes of Japanese medical students toward career development, including the acquisition of medical specialty and doctorate degree qualifications.

DESIGN

This involved a web-based questionnaire survey.

SETTING

We asked medical students about attitudes toward career development after graduation. We also asked them about their intentions to acquire a medical specialty and a doctorate degree using a 5-point Likert scale.

PARTICIPANTS

All 699 medical students (from first to sixth grade) in our medical school.

RESULTS

The overall questionnaire response rate was 66.5% (465 of 699). Over 90.3% (420 of 465) of respondents desired the clinical discipline, while only 10 of 465 respondents (2.2%) did for basic research. Awareness of career development for ≥8 years after graduation was significantly lower compared with that for 1-2 years after graduation among fourth-sixth year students (fourth p=0.0023, fifth p<0.001, sixth p<0.001). Awareness of career development for 3-7 years after graduation was significantly lower compared with that for 1-2 years after graduation among third-sixth year students (third p<0.001, fourth p=0.003, fifth p<0.001, sixth p<0.001). In the sixth year medical students, only 10.3% showed strong awareness of career development for ≥8 years after graduation, while 39.7% of them did for 1-2 years after graduation. Intentions to acquire a doctorate degree were significantly weaker than those for a medical specialty in all years (p<0.001 in all grades).

CONCLUSION

Most Japanese medical students concentrated on the 2-year initial training period immediately after graduation, with vague plans for the subsequent years. Intentions to acquire a doctoral degree were significantly lower than those for a medical specialty. Our findings underscore the necessity for a comprehensive, longitudinal and systematic career development programme.

Perceptions of senior nursing students on how the COVID-19 pandemic influenced their clinical practice in the Northwest Province, South Africa: a qualitative study

OBJECTIVE

To explore and describe senior nursing students' perspectives on clinical practice during COVID-19 and provide the most up-to-date information on the quality of clinical experience for nursing students in relation to nursing practice, nursing education, and nursing research.

DESIGN

The research design that was employed is a qualitative, explorative, descriptive in order to explore and describe nursing students' perceptions of clinical, training during the COVID-19 pandemic.

SETTING

The study took place in a local university located in the Northwest province, South Africa.

PARTICIPANTS

The population consisted of 16 senior nursing students who had been exposed to clinical practice during the COVID-19 pandemic. There were 14 women and 2 men. Study included full-time, registered undergraduate nursing students who enrolled in 2019. All nursing students who did not engage in clinical practice before or during COVID-19 were exempt.

INTERVENTIONS

There were no direct interventions in this study; however, few recommendations were made for each of the themes that emerged in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The researchers' aim with the study was to find out the nursing students' perspective on clinical training during a global pandemic, through interviews and focus group discussions. The researcher did in fact receive such feedback from the participants.

RESULTS

Four major themes emerged: (1) the lack of preceptors to facilitate clinical teaching; (2) not allowed to work in COVID-19 wards; (3) difficulties with online classes and tests and (4) poor communication.

CONCLUSION

The COVID-19 pandemic influenced how students viewed and experienced clinical training, which in turn had an impact on their learning experiences. These effects also had some impact on their experiences and decisions to continue working as professional nurses.

Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the UK

OBJECTIVE

To better understand the broader experience of medical students impacted by discrimination and the support systems they engage with.

DESIGN

Qualitative study using semi-structured interviews.

SETTING

Four medical schools based in the UK.

PARTICIPANTS

17 medical students were recruited using volunteer and snowball sampling: all students self-identified as being impacted by discrimination.

RESULTS

5 themes were identified: feelings of isolation, imposter syndrome and exclusion; a lack of representation and positive role modelling; the importance of peer support; issues relating to the accessibility of support; building support networks through shared experiences and attempts to foster a sense of inclusion through peer and institutionally led initiatives.

CONCLUSIONS

The findings of this study suggest medical schools could do more to recognise the importance of acknowledging the multiple identities at risk of discrimination held by students, perpetuating feelings of isolation and exclusion. Our research highlights the need for practical systemic initiatives to improve the sense of belonging of medical students who are impacted by discrimination. Medical educators and institutions should consider formal and informal provisions, such as creating time and space for students to meet and share experiences, access support and reporting networks, to foster a greater sense of belonging.

Perceptions of academic staff and students of senior high school in implementing game-based exercises in physical education classes-a research protocol for a qualitative descriptive study

BACKGROUND

The COVID-19 pandemic has taken a toll on both physical activity and fitness as several pursuits and activities have been restricted. Coupled with this, increased food intake and sedentary lifestyles have produced poor physical health outcomes. Online physical education classes have been more difficult to conduct given the limitations of the setup. As such, exergaming has been identified as a possible educational tool that could improve students' motivation, participation and fitness levels and reduce negative behaviours in class while contributing to the current curriculum.

OBJECTIVES

The study explores the perspectives of both the physical education academic staff and senior high school students from the University of Santo Tomas on the implementation of exergaming to determine the feasibility of exergaming as an educational tool in the Philippines' physical education curriculum.

METHODOLOGY

A descriptive qualitative design will be used and participants will be selected through criterion sampling. The authors will conduct a process of question development and pilot FGDs beforehand to ensure smooth proceedings. Once done, they will undergo FGDs conducted through Google Meet. Data will be coded and analysed via thematic analysis using manual coding and NVivo V.12 software to summarise central themes and perceptions.

ETHICS AND DISSEMINATION

This study will abide by the Nuremberg Code, Declaration of Helsinki, Belmont Report, Data Privacy Act of 2012 and National Ethical Guidelines (for health-related research) of 2017. The study has received approval from the University of Santo Tomas (UST)-College of Rehabilitation Sciences (CRS) Ethics Review Committee. All participant data will be labelled according to random two-digit computer generated codes to preserve anonymity and stored in password-protected laptops and Google Drive folders to preserve confidentiality. Results will be made available to individual UST physical education academic staff and senior high school students prior to publication in peer-reviewed journal.

Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study

OBJECTIVES

To better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority ethnicity subgroups (Bangladeshi, black, Chinese, Indian, Pakistani, mixed, other Asian background and other ethnic background) and whether the AG varies by medical school attended.

DESIGN

Retrospective cohort study.

SETTING

Data extracted from the UK Medical Education Database on students enrolled at 33 UK medical schools in the academic years starting 2012, 2013 and 2014.

PARTICIPANTS

16 020 'Home' tuition fee status students who sat the University Clinical Aptitude Test on entry to university and obtained a UK Foundation Programme (UKFP) application score on exit.

PRIMARY OUTCOME MEASURE

UKFP Z-scores on exit from medical school.

RESULTS

There were significant differences in UKFP Z-scores between ethnicity subgroups. After white students, mixed ethnicity students performed best (coefficient -0.15 standard deviations [SD]) compared with white students, (95% confidence interval [CI] -0.23 to -0.08, p<0.001) and Pakistani students scored lowest (coefficient -0.53 SD, 95% CI -0.60 to -0.46, p<0.001). In pairwise comparisons of scores between all nine individual ethnicity subgroups, 15/36 were statistically significant. The AG varied considerably across medical schools. The largest gap showed the coefficient for BAME was -0.83 SD compared with white students (95% CI -1.18 to -0.49, p<0.001), while the smallest demonstrated no statistically significant difference in performance between BAME and white students (+0.05 SD, 95% CI -0.32 to 0.42, p=0.792).

CONCLUSIONS

BAME students are significantly disadvantaged by the current UK medical education system. There are clear differences in medical school outcomes between students from different ethnicity subgroups, and the size of the AG also varies by medical school attended. Urgent and effective action must be taken to address the AG and achieve an equal learning environment for our future doctors.

Protocol for a systematic review of reviews on training primary care providers in dermoscopy to detect skin cancers

INTRODUCTION

Globally, incidence, prevalence and mortality rates of skin cancers are escalating. Earlier detection by well-trained primary care providers in techniques such as dermoscopy could reduce unnecessary referrals and improve longer term outcomes. A review of reviews is planned to compare and contrast the conduct, quality, findings and conclusions of multiple systematic and scoping reviews addressing the effectiveness of training primary care providers in dermoscopy, which will provide a critique and synthesis of the current body of review evidence.

METHODS AND ANALYSIS

Four databases (Cochrane, CINAHL, EMBASE and MEDLINE Complete) will be comprehensively searched from database inception to identify published, peer-reviewed English-language articles describing scoping and systematic reviews of the effectiveness of training primary care providers in the use of dermoscopy to detect skin cancers. Two researchers will independently conduct the searches and screen the results for potentially eligible studies using 'Research Screener' (a semi-automated machine learning tool). Backwards and forwards citation tracing will be conducted to supplement the search. A narrative summary of included reviews will be conducted. Study characteristics, for example, population; type of educational programme, including content, delivery method, duration and assessment; and outcomes for dermoscopy will be extracted into a standardised table. Data extraction will be checked by the second reviewer. Methodological quality will be evaluated by two reviewers independently using the Critical Appraisal Tool for Health Promotion and Prevention Reviews. Results of the assessments will be considered by the two reviewers and any discrepancies will be resolved by team consensus.

ETHICS AND DISSEMINATION

Ethics approval is not required to conduct the planned systematic review of peer-reviewed, published articles because the research does not involve human participants. Findings will be published in a peer-reviewed journal, presented at leading public health, cancer and primary care conferences, and disseminated via website postings and social media channels.

PROSPERO REGISTRATION NUMBER

CRD42023396276.

Socio-demographic profile of medical students in Aotearoa, New Zealand (2016-2020): a nationwide cross-sectional study

OBJECTIVE

To determine the socio-demographic profile of all students enrolled to study medicine in Aotearoa New Zealand (NZ).

DESIGN AND SETTING

Observational, cross-sectional study. Data were sought from the Universities of Auckland and Otago, the two NZ tertiary education institutions providing medical education, for the period 2016-2020 inclusive. These data are a subset of the larger project 'Mirror on Society' examining all regulated health professional enrolled students in NZ.

VARIABLES OF INTEREST

gender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. NZ denominator population data (18-29 years) were sourced from the 2018 census.

PARTICIPANTS

2858 students were enrolled to study medicine between 2016 and 2020 inclusive.

RESULTS

There were more women (59.1%) enrolled to study medicine than men (40.9%) and the majority (96.5%) were in the 18-29 years age range. Māori students (rate ratio 0.92; 95% CI 0.84 to 1.0) and Pacific students (rate ratio 0.85; 95% CI 0.73 to 0.98) had lower overall rates of enrolment. For all ethnic groups, irrespective of rural or urban origin, enrolment rates had a nearly log-linear negative relationship with increasing socioeconomic deprivation. Enrolments were lower for students from rural areas compared with those from urban areas (rate ratio 0.53; 95% CI 0.46-0.61). Overall NZ's medical students do not reflect the diverse communities they will serve, with under-representation of Māori and Pacific students and students who come from low socioeconomic and rural backgrounds.

CONCLUSIONS

To meaningfully address these issues, we suggest the following policy changes: universities commit and act to Indigenise institutional ways of knowing and being; selection policies are reviewed to ensure that communities in greatest need of doctors are prioritised for enrolment into medicine (specifically, the impact of low socioeconomic status should be factored into selection decisions); and the government fund more New Zealanders to study medicine.

Initial prescriptions and medication switches of biological products: an analysis of prescription pathways and determinants in the Swiss healthcare setting

OBJECTIVES

Biological products have contributed to extraordinary advances in disease treatments over the last decade. However, the cost-saving potential of imitator products, so-called biosimilars, is still under-researched in Switzerland. This study aims to assess biosimilars' prescriptions at treatment initiation and their determinants, as well as biological therapy switches.

DESIGN

The study included all patients who had at least one biosimilar available on the market at the time when they were prescribed a biological product. We analysed longitudinal data for biosimilar prescriptions in Switzerland using descriptive statistics and logistic regression to quantify the associations with individual, pharmaceutical and provider-related variables.

SETTING

The analysis is based on de-identified claims data of patients with mandatory health insurance at Helsana, one of the Swiss health insurance companies with a substantial enrollee base in mandatory health insurance.

PARTICIPANTS

Overall, 18 953 patients receiving at least one biological product between 2016 and 2021 were identified.

OUTCOME MEASURES

We differentiated between initial prescriptions and follow-up prescriptions. Our regression focused on initial prescriptions due to evidence indicating that patients tend to follow the medication prescribed at therapy initiation.

RESULTS

Although biosimilars' market share was low (28.6%), the number of prescriptions has increased (from 1016 in 2016 to 6976 in 2021). Few patients with medication switches (n=1492, 8.5%) were detected. Increased relative price difference (difference in the price of available biosimilars relative to price of corresponding reference product) was associated with decreased probability of biosimilar prescriptions, whereas male sex, an increase of available imitator drugs on the market, larger packaging sizes, and prescriptions from specialists or physicians in outpatient settings were associated with increased biosimilar use.

CONCLUSION

The low number of biosimilar prescriptions, despite the proliferating biosimilar market, indicates a high potential for biosimilar diffusion. The findings indicate that patients typically adhere to the therapy options initially chosen and are less inclined to make changes following the initiation of treatment. Our research highlights the need for awareness initiatives to improve understanding among patients and physicians, enabling informed, shared decision-making about biosimilar prescriptions.

Using nominal group technique to identify the planning considerations for UK Armed Forces medical personnel delivering defence engagement first aid training activities

INTRODUCTION

Defence Medical Services personnel regularly deploy overseas to deliver training activities as part of defence engagement (DE) to positively influence partners and others. There remains scope for medical planners to enhance our understanding of how to optimally use medical staff and assets for DE. We aimed to develop a tool to improve planning for DE activities delivering first aid training.

METHODS

We used nominal group technique to conduct a focus group with UK experts in planning first aid training DE activities to identify and prioritise important planning considerations within a conceptual framework based on the Defence Lines of Development. We validated and refined this framework with international experts from partner nation militaries to help strengthen the final planning tool.

RESULTS

We developed a detailed tool covering training curriculum and logistical and infrastructure requirements to deliver safe and effective DE training activities. First aid training engagement priorities include being tailored to the training audience and in harmony with the national or military healthcare services of that country. Messaging around the women, peace and security agenda should be integrated into training packages at conception to be effective.

CONCLUSIONS

We propose a planning tool to aid in designing first aid training that considers the necessary components to support meaningful education and effective engagement in support of UK's strategic goals. We welcome the use of and feedback on this tool and its impact to those planning first aid training activities as part of DE operations.

Workplace-based learning about health promotion in individual patient care: a scoping review

OBJECTIVE

To outline current knowledge regarding workplace-based learning about health promotion in individual patient care.

DESIGN

Scoping review.

DATA SOURCES

PubMed, ERIC, CINAHL and Web of Science from January 2000 to August 2023.

ELIGIBILITY CRITERIA

We included articles about learning (activities) for healthcare professionals (in training), about health promotion in individual patient care and in the context of workplace-based learning.

DATA EXTRACTION AND SYNTHESIS

The studies were evaluated using a charting template and were analysed thematically using a template based on Designable Elements of Learning Environments model.

RESULTS

From 7159 studies, we included 31 that described evaluations of workplace-based learning about health promotion, around a variety of health promotion topics, for different health professions. In the articles, health promotion was operationalised as knowledge, skills or attitudes related to specific lifestyle factors or more broadly, with concepts such as health literacy, advocacy and social determinants of health. We assembled an overview of spatial and instrumental, social, epistemic and temporal elements of learning environments in which health promotion is learnt.

CONCLUSIONS

The studies included in our analysis varied greatly in their approach to health promotion topics and the evaluation of learning outcomes. Our findings suggest the importance of providing opportunities for health profession learners to engage in authentic practice situations and address potential challenges they may experience translating related theory into practice. Additionally, our results highlight the need for conscious and articulated integration of health promotion in curricula and assessment structures. We recommend the exploration of opportunities for health profession students, professionals and patients to learn about health promotion together. Additionally, we see potential in using participatory research methods to study future health promotion learning.

STUDY REGISTRATION

Open Science Framework, https://doi.org/10.17605/OSF.IO/6QPTV.

Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

OBJECTIVES

To design, develop, deliver and assess a training initiative on haemorrhage control for emergency medical services (EMS) staff in Ukraine, in an active wartime setting.

DESIGN

Using the Medical Research Council framework for complex interventions, a training programme was designed and developed in a collaboration between Irish and Ukrainian colleagues and delivered by experienced prehospital clinicians/educators. Feedback was gathered from participants.

SETTING

The Russian invasion of Ukraine has caused large numbers of trauma patients with limited access to advanced prehospital emergency care. Ukrainian authorities requested support in delivering such care.

PARTICIPANTS

Ukrainian EMS nominated clinical staff as trainees, in partnership with an educational institution in Kyiv.

INTERVENTION

One day provider and train-the-trainer courses were developed and delivered, focused on early delivery of tranexamic acid (TXA), using intraosseous access (IO) in victims of wartime trauma.

OUTCOME MEASURES

Safe organisation and delivery of courses, assessed knowledge and skills competence and self-reported satisfaction and pre/post confidence/competence.

RESULTS

Two provider and one train-the-trainer courses and four equipment supply exercises were delivered for 89 EMS staff (doctors, nurses, paramedics); none had prior experience of IO or prehospital delivery of TXA. All participants were assessed as competent as providers and/or trainers. High levels of satisfaction and significantly improved self-assessed confidence and competence were reported.

CONCLUSION

Rapid design and delivery of a training programme focused on an identified need for advanced care of trauma patients in a wartime setting has been possible. Training and immediate access to appropriate equipment was demonstrated. Evidence of frequency of use and safe, effective interventions has not been collected; such data are important for evaluation but difficult to collect in this setting. A high level of demand for this training now exists.

Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites

OBJECTIVE

Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave.

DESIGN

Cohort study.

SETTING AND INTERVENTION

Five Danish hospitals.

PARTICIPANTS

A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study.

INTERVENTION

From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group.

OUTCOME MEASURES

Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention).

RESULTS

Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group.

CONCLUSION

The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.

Identifying costs in health professions education: a scoping review protocol

INTRODUCTION

Profound changes in the healthcare sector and the growing, global shortage of healthcare workers are driving the demand to update and scale-up health professions education (HPE). At the same time, educational institutions are faced with increasing resource scarcity and decisions of where and how to allocate resources must be made conscious of costs. However, costs are known to be inaccurately and incompletely identified in HPE research. Therefore, to improve rigour in cost evidence and enable its use in decision-making, it is necessary to have a better understanding of the costs, stakeholders and cost identification methods being used in HPE research. This protocol has been developed to outline the rationale and methods for a scoping review of the literature intended to map the current state of cost and cost identification evidence in HPE.

METHODS AND ANALYSIS

This protocol is developed in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis. PubMed, ERIC, CINAHL and PsycInfo will be scoped for all types of English language publications from 2012 to 2022 that investigate costs associated with the education of health professionals. Two independent reviewers will assess publications for eligibility. Data will be extracted on the educational topic and context, the costs, cost types, perspectives and methods of cost identification as represented in the literature.

ETHICS AND DISSEMINATION

No human participants are involved in this scoping review. All evidence for this study are sourced from public databases; therefore, ethical approval was not required. Final results will be disseminated through peer-reviewed publications and presented at conferences.

TRIAL REGISTRATION NUMBER

A preliminary version of this protocol was prospectively registered on Open Science Framework (OSF) on 13 June 2022 and is available at https://doi.org/10.17605/OSF.IO/ET4XB.

How self-regulated learning influences undergraduate medical students to conduct student-centred learning: a scoping review protocol

INTRODUCTION

Self-regulated learning is one of the influencing factors in successful learning. There is a need to understand the factors influencing self-regulated learning in undergraduate medical students in implementing a student-centred learning curriculum. This scoping review aims to systematically identify and map undergraduate medical students' self-regulated learning during student-centred learning implementation and to learn the tools used to measure it.

METHODS AND ANALYSIS

The scoping review will use Arksey and O'Malley's proposed five-stage framework guideline. A search for published literature between 2012 and 2022 in the five electronic databases of EBSCOHost, Science Direct, Scopus, ProQuest and PubMed will be conducted using keywords to identify relevant studies. Articles will be limited to the English language. Mendeley software will eliminate duplicates, and results will be exported into abstracts for two stages of the screening process: title and abstract reviews and full-text reviews. The selection process of eligible literature will be reported using the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist recommendations. Studies using qualitative and quantitative data from all world regions will be considered. To be included, studies should examine medical students' self-regulated learning in a student-centred learning approach curriculum. A data chart will capture relevant information from all the included studies. As a scoping review, no assessment of the studies' quality and risk of bias will be made. Results will be presented in tabular form and a narrative report.

ETHICS AND DISSEMINATION

No Ethics Committee or Institutional Board approval is required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and professional networks.

Mindfulness for academic performance in health professions students: a systematic review

OBJECTIVES

To systematically review the impact of mindfulness-based interventions (MBIs) on the academic performance of undergraduate medicine, nursing and allied health students.

METHODS

Randomised controlled trials that examined the effects of MBIs in medicine, nursing and allied health students on academic performance were eligible for inclusion. Electronic database searches were conducted across Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), PsycINFO and ERIC databases. Two authors independently reviewed citations, extracted data and assessed the quality of evidence using the Cochrane Collaboration's risk of bias tool. A descriptive analysis of included studies and a meta-analysis using a random-effects model of standardised mean difference were performed.

RESULTS

A total of 267 studies were returned from the search, of which 2 met the inclusion criteria. The overall risk of bias was assessed as unclear risk of bias for one study and high risk of bias for second included study. A meta-analysis of MBIs on student academic performance as measured by marks in written examination indicated no statistical difference between interventions (Standardised Mean Difference (SMD)=0.43, 95% CI -1.77 to 2.62, I2=96%).

DISCUSSION

Our systematic review highlights a lack of evidence to either support, or refute, the use of mindfulness interventions on the academic performance of undergraduate medical students. We encourage that future randomised controlled trials pay heed to the dosing of mindfulness and include a measurement of mindfulness to enable us to draw a clearer causal relationship.

Confusion among doctors regarding sports and exercise medicine as a specialty: an Australian multidisciplinary, cross-sectional survey

OBJECTIVES

This cross-sectional study aims to characterise the understanding and attitudes medical practitioners have towards sports and exercise medicine (SEM). By identifying knowledge gaps, misunderstandings and barriers to SEM referral, interventions may be suggested to improve the integration of SEM within a multidisciplinary approach to healthcare.

DESIGN

A survey was constructed with a multidisciplinary expert panel. Refinement and consensus were achieved through a modified Delphi method. Both quantitative and qualitative data were analysed and intergroup comparisons made using χ2 test of independence and post-hoc paired comparisons.

SETTING

The questionnaire was distributed across Australian public and private health sectors, in community and hospital-based settings.

PARTICIPANTS

Australian medical doctors practising in specialties likely to intersect with SEM were invited; including general practice, orthopaedics, emergency, rheumatology and anaesthetics/pain. Invitation was uncapped with no reportable response rate. A total of 120 complete responses were collected RESULTS: The minority (42.5%) of respondents understood the role and scope of sports and exercise physicians. SEM was poorly recognised and comprehended, with the most common misconception being that SEM is solely for elite athletes and performance. Few (20%) doctors were familiar with referral pathways to SEM services. Lack of awareness, clear scope and public presence were seen as major barriers. There was near unanimous (92.5%) agreement that 'exercise is medicine'. A strong majority felt SEM would be valuable to collaborate with more in their current practice (63.3%) and as a part of the Australian public health system (82.5%). There were some significant differences among subgroups, including that junior doctors were more likely to express confusion about SEM.

CONCLUSIONS

Among non-SEM doctors, there is significant lack of clarity regarding the role of SEM and its optimal integration. Interdisciplinary education and addressing misconceptions may improve the contribution of SEM to community healthcare.

Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students' longitudinal experiences in primary care

OBJECTIVE

Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school.

DESIGN

We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis.

SETTING

One research-intensive medical school based in the UK. Data collection occurred in 2021-2022.

PARTICIPANTS

12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year.

RESULTS

We constructed four themes capturing insights on how hidden curricula influenced students' experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning.

CONCLUSIONS

The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.

Exploring the development of a framework of social accountability standards for healthcare service delivery: a qualitative multipart, multimethods process

OBJECTIVES

Social accountability is an equity-oriented health policy strategy that requires institutions to focus on local population needs. This strategy is well established in health professional education, but there is limited understanding of its application in healthcare service delivery. Building on what is known in the education setting, this study aimed to explore the development of a framework of comprehensive, evidence-based social accountability standards for healthcare service delivery institutions.

DESIGN

This qualitative, multipart, multimethods study consisted of a modified Delphi process guided by an evidence-based social accountability tool for health professional education and complementary methods including developmental evaluation and a review of select literature to capture emerging evidence and contextual relevance.

SETTING

The study took place in Northern Ontario, Canada at a medical school and a tertiary, regional academic health sciences centre that are both grounded in social accountability.

PARTICIPANTS

Eight expert participants from diverse, multidisciplinary backgrounds, including a patient advocate, were purposefully recruited from both institutions, enrolled and seven completed the study.

MAIN OUTCOME

The resulting framework of social accountability standards is organised into 4 major sections that capture broad and critical concepts; 17 key component reflective questions that address key themes; 39 aspirations that describe objective standards and 197 indicators linked to specific expectations.

RESULTS

Three modified Delphi rounds were completed producing a framework of consensus derived standards. Developmental evaluation helped identify facilitators, barriers and provided real-time feedback to the study's processes and content. The literature reviewed identified 10 new concepts and 43 amendments.

CONCLUSION

This study highlights the development of a comprehensive, evidence-based framework of social accountability standards for healthcare service delivery institutions. Future studies will aim to evaluate the application of these standards to guide equity-oriented social accountability health policy strategies in healthcare service delivery.

Impact of medical students' socioeconomic backgrounds on medical school application, admission and migration in Japan: a web-based survey

OBJECTIVES

The aim of this study was to clarify and compare the socioeconomic backgrounds of medical students with those of other health professions and non-health faculty students in an era of increasing inequity in Japanese society.

DESIGN

This was a quantitative nationwide study. Data were collected by a cross-sectional web-based anonymous questionnaire.

SETTING

Data from years 3 and 4 medical, health professions and non-health faculty students across Japan were collected in 2021.

PARTICIPANTS

Participants were 1991 students from medical schools, 224 from dental, 419 from pharmacy, 326 from nursing, 144 from other health professions and 207 from non-health faculties.

RESULTS

The proportion of high-income families (>18 million yen: ca. US$140 000) among medical students was 25.6%, higher than that of pharmacy (8.7%) and nursing students (4.1%) (p<0.01). One-third of medical students had a physician parent, more common than in non-medical students (p<0.01). Students who only applied to public medical schools and a regional quota 'Chiiki-waku' students with scholarship had lower family income and physician parents compared with those who applied to private medical schools (p<0.01), but they still had higher physician parents compared with non-medical students (p<0.01). Logistic regression revealed that having a physician parent (p<0.01), aspiring to the present profession during elementary school (p<0.01) and private upper secondary school graduation (p<0.01) predicted the likelihood of studying medicine. There were regional differences of backgrounds among medical students, and 80% of medical students with urban backgrounds intended to work in urban localities after graduation.

CONCLUSIONS

This study provides evidence that medical students in Japan hail from urban and higher income classes and physicians' families. This finding has implications for the health workforce maldistribution in Japan. Widening the diversity of medical students is essential for solving physician workforce issues and meeting broad healthcare needs.