When I say … 'non-clinical practice'

In recent years, we have seen the emergence of the term 'non-clinical practice' used in the literature and the healthcare field more broadly. However, there has not yet been a critical examination of what this term means and how it may subtly influence the social reality and culture of healthcare practice. Based on the available literature and the authors' lived experience, we position this article and the term 'non-clinical practice' relative to medical doctors. However, the tenets of the argument below are true for any healthcare practitioner. Taking a social constructivist approach, we critically analyse the term 'non-clinical practice' and explain why readers should challenge its use.

Educational interventions for imposter phenomenon in healthcare: a scoping review

BACKGROUND

Imposter Phenomenon (IP) is a subjective feeling of intellectual fraudulence and self-doubt experienced by individuals in goal-orientated high-achieving professions. The impact of IP within healthcare has been associated with individual physical and mental health and concerns around training, career progression and DEI at an institutional level. To effectively address IP in healthcare, this scoping review aims to explore educational interventions designed to empower high-achieving individuals with the tools needed to confront and overcome IP.

METHODS

The scoping review adhered to a predetermined protocol informed by the JBI methodology and PRISMA-ScR guidelines in order to identify educational interventions addressing IP in high-achieving industries. Articles were searched across multiple databases, including MEDLINE (Ovid), PsychINFO, SCOPUS, and Web of Science, alongside grey literature, without imposing any time constraints. A systematic approach including a thematic analysis allowed for a nuanced exploration and interpretation of the identified educational interventions and their impact on addressing IP.

RESULTS

Seventeen articles were incorporated into the review, with the majority originating from the USA and majority being published since 2020. Ten studies targeted healthcare professionals, undergraduate and postgraduate healthcare students. Majority of studies aimed at addressing IP, featured a larger number of female participants than males. Workshops with self-reflection and group-guided exercises to overcome IP were the most popular educational interventions. Coaching and structured supervision were also suggested. Across all papers, three themes emerged for coping strategies: individual, peer-to-peer, and institutional.

CONCLUSIONS

This scoping review suggests how group and individual interventions such as workshops, small group discussions and coaching can be used to overcome IP in healthcare. Institutional changes like diversity promotion, supervisor education, and support networks are crucial in addressing IP. Further long term and speciality specific assessments are needed to measure impact. Overall, the review highlights how educational awareness and a variety of strategies can be implemented to create a supportive environment for professionals dealing with IP, promoting their well-being and success.

Beyond the bedside: protocol for a scoping review exploring the experiences of non-practicing healthcare professionals within health professions education

BACKGROUND

The number of healthcare professionals leaving clinical practice and transitioning to alternative careers in health professions education is increasing. Among these non-practicing healthcare professionals, concerns have been reported regarding tensions in relation to identity, role, and credibility in their new field. There are suggestions that this is a particularly pressing issue for minoritised professionals who make this transition. Support is critical to attract and retain diverse talent within health professions education teaching and research. The purpose of this scoping review is to explore the career experiences of non-practicing healthcare professionals who work in health professions education internationally.

METHODS

Arksey and O'Malley's framework has been utilised to guide the design of this scoping review process and will be used throughout the course of the review. A comprehensive search of seven electronic databases and limited search of Google Scholar will be conducted, as well as a hand search of eligible article reference lists. Two reviewers will independently screen all articles based on inclusion criteria, with conflicts resolved by a third reviewer. Data from included articles will be charted, collated, and analysed thematically. Meta-data will be summarised quantitatively.

DISCUSSION

This scoping review aims to explore the role and experiences of non-practicing healthcare professionals working within health professions education. The review will follow established scoping review guidelines and will include studies from various regions and languages, provided an English translation is available. The study remit will be broad, including both quantitative and qualitative studies, as well as reviews and opinion papers. Limitations may include the exclusion of non-English articles and potential difficulty of identifying papers which discuss the experiences of non-practicing clinicians. However, the review will provide insight into the current knowledge on what it is like to be a non-practicing clinician working within health professions education and identify gaps for both future research, and future support for those making this career transition.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Registration  https://doi.org/10.17605/OSF.IO/485Z3.

Under- and post-graduate training to manage the acutely unwell patient: a scoping review

BACKGROUND

Junior doctors are often the first responders to acutely unwell patients and yet frequently report feeling under-prepared to do so. To understand whether this is consequential of how medical students and doctors are trained to manage acutely unwell patients, a scoping review was conducted using a systematic approach.

METHODS

The review, informed by the Arksey and O'Malley and PRISMA-ScR guidelines, identified educational interventions targeting the management of acutely unwell adults. Seven major literature databases were searched for journal articles published in English from 2005 to 2022, in addition to the Association of Medical Education in Europe (AMEE) conference proceedings from 2014 to 2022.

RESULTS

Seventy-three articles and abstracts were eligible for the review, the majority of which were from the UK or USA, and demonstrated that educational interventions were more commonly targeted at medical students than qualified doctors. The majority of studies used simulation, but very few integrated complexities of the clinical environment within scenarios such as multidisciplinary working, distraction-handling techniques and other non-technical skills. A wide range of learning objectives pertaining to acute patient management were stated across studies, but few explicitly cited educational theory underpinning their study.

CONCLUSIONS

The results of this review encourages future educational initiatives to consider enhancing authenticity within simulation to promote transfer of learning to clinical practice, and use educational theory to augment the sharing of educational approaches within the community of clinical education practice. Additionally, increasing the focus on post-graduate learning, building upon undergraduate educational foundations, is essential to promoting lifelong learning within the ever-changing healthcare environment.

Twelve tips for organising a local or regional e-poster session

E-posters have been increasingly incorporated into medical education conferences over the past few years, but since the disruption to the 'traditional' conference circuit as a result of COVID-19 pandemic in 2020 they have become a necessary tool for larger national and international conferences to support ongoing scholarship dissemination. The authors of this article also recognise the potential for smaller-scale e-poster sessions to be organised at local or regional levels to either continue, or establish new, special interest groups and smaller medical education research networks. Our 12 tips article is designed to offer practical advice to support the implementation of local or regional e-poster sessions to potential organisers and is written from the perspective of two medical educational researchers with experience of designing e-posters and organising virtual conferences which include e-poster presentation sessions.

The F3 phenomenon: Early-career training breaks in medical training. A scoping review

BACKGROUND

Since 2017, more than 50% of UK doctors have undertaken a 'Foundation 3 (F3) Year' training break after completing their foundation programme (the first two years following graduation), rather than immediately enter specialty training. The reasons for, and consequences of, the growing F3 trend are largely unknown. This scoping review presents the current evidence and identifies future research in this field.

METHODS

Following Arksey and O'Malley's guidelines, 12 databases and three UK-based national postgraduate organisation websites were searched for articles published in English (final searches January 2020). Multiple search terms were used to capture articles relating to the 'F3' time-period, including 'post-foundation' or 'pre-specialty' training. Title, abstract and full-paper screening selected articles reporting any aspect of F3, including within a wider context (eg postgraduate training breaks), and then underwent mixed-methods analysis.

RESULTS

Of 4766 articles identified, 45 were included. All articles were published after 2009; 14/45 (31.1%) were published in 2019. 27 articles reported research, and the remainder were opinion/commentaries. Specific personal (including demographic), professional and organisational factors, particularly the UK postgraduate training structure, are associated with undertaking an F3. The majority of F3 training breaks last 1 year and involve working (clinically or non-clinically) and/or travel. The decision to undertake an F3 is made either prior to or during foundation training. Evidence regarding the impact of F3 on health care service provision was limited but evenly balanced.

CONCLUSIONS

In summarising the existing F3 evidence, this review has highlighted important issues including health care workforce equality and diversity, training pathway inflexibility and the effect of negative early-career experiences on subsequent career decisions. More research is needed to understand the financial impact of training breaks on health care service provision, how training programmes must adapt to retain more trainees and the long-term effects of training breaks, such as F3, on subsequent career progression.

Using Insights From Sports Psychology to Improve Recently Qualified Doctors' Self-Efficacy While Managing Acutely Unwell Patients

PROBLEM

Doctors experience a range of negative reactions when managing acutely unwell patients. These may manifest as emotions or behaviors. Without appropriate coping strategies, these emotions and behaviors can impede optimal clinical performance, which directly affects patient care. Athletes use performance enhancing routines (PERs) to minimize the effect of their negative emotions and behaviors on competitive performance. The authors investigated whether PERs could similarly improve recently qualified doctors' emotional and behavioral control while managing acutely unwell patients and whether the doctors perceived any effect on clinical performance.

APPROACH

Twelve doctors within 2 years of graduation from medical school recruited from 2 sites in Sheffield and Chesterfield, United Kingdom, implemented PERs using the PERFORM (Performance Enhancing Routines For Optimization of Readiness using Metacognition) model over a 4-month period between April and December 2017. The doctors' perceptions of PERFORM's effect on their ability to manage patients was evaluated using self-reported mixed-methods data, including think-aloud commentaries, semistructured interviews, and self-efficacy scores.

OUTCOMES

Doctors reported that PERFORM improved their ability to control negative emotions or behaviors during an acutely unwell patient in situ simulation, showing a statistically significant improvement in self-efficacy scores (P = .003, effect size = 0.89). Qualitative data revealed perceived improvement in aspects of clinical performance such as enhanced knowledge recall and decision making. These performance attributes appeared to positively impact interprofessional relationships and patient care. Doctors individualized their PERs and supported the wider implementation of PERFORM in health care education.

NEXT STEPS

This is the first study to employ individualized PERs based on sports psychology in a medical context. The PERFORM model could be introduced into existing acute patient management courses to provide emotional regulation coaching alongside clinical skills training. Further research might investigate PERFORM's effect in other environments where emotional and behavioral control is paramount, such as surgery.

Applying sport psychology to improve clinical performance. Med Teach 2017;39:1205-1213. [PMID: 28784016 DOI: 10.1080/0142159x.2017.1359523]

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

Twelve tips for choosing and surviving a PhD in medical education - a student perspective

The decision to undertake a PhD in medical education could mark a critical point in defining your future career. Attaining the highest level of degree in such a diverse and rewarding area as medical education may not only provide you with an opportunity to undertake important new research, but could also unlock different job opportunities. As is often the case, such rewards are not gained lightly. There can be real challenges in making the decision to undertake and then to successfully navigate a PhD. The specific subject and process of each doctorate is unique, leaving many prospective and current students uncertain as to what to expect. We offer our twelve tips from the perspective of two current PhD students to help guide those who share our interest in medical education and are considering doctoral study.