Imperial College London

DrKayLeedham-Green

Faculty of MedicineFaculty of Medicine Centre

Medical Education Fellow (Education Research)
 
 
 
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Contact

 

k.leedham-green Website

 
 
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Location

 

277Sir Alexander Fleming BuildingSouth Kensington Campus

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Summary

 

Publications

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26 results found

Badger K, Morrice R, Buckeldee O, Cotton N, Hunukumbure A, Mitchell O, Mustafa A, Oluwole E, Pahuja J, Davies D, Morrell M, Smith S, Leedham-Green Ket al., 2021, "More than just a medical student”: a mixed methods exploration of a structured volunteering programme for undergraduate medical students, BMC Medical Education, ISSN: 1472-6920

Background As a result of the COVID-19 pandemic Imperial College School of Medicine developed a structured volunteering programme involving 398 medical students, across eight teaching hospitals. This case study aims to illuminate the experiences of volunteers, mechanisms of learning and draw lessons for future emergencies and curriculum improvements. Methods Using an illuminative approach to evaluation we invited all volunteers and supervisors to complete a mixed-methods survey. This gathered nominal demographic information and qualitative data related to motivations, experiences, insights into learning, processual and contextual factors. Qualitative responses were coded, thematically organised, and categorised into an overarching framework. Mann-Whitney U tests determined whether volunteers’ overall rating of the experience varied according to demographic features and modulating factors. Spearman’s rank correlation assessed the relationship between aspects of induction and supervision, and overall volunteering rating. Follow up interviews were carried out with students to check back findings and co-create conclusions. Results Modulating factors identified through thematic analysis include altruistic motivation, engaged induction and supervision, feeling valued, having responsibility and freedom from the formal curriculum. Statistically significant positive correlations are identified between volunteers overall rating and being a year 1 or 2 student, ability to discuss role and ask questions during induction, being male, and having regular meetings and role support from supervisors. Qualitatively reported impacts include improved wellbeing, valuable contribution to service and transformative learning. Transformative learning effects included reframing of role within the multidisciplinary team, view of effective learning and view of themselves as competent clinicians. The number of weeks, number of shifts per week, and the role the volunteers performed

Journal article

Marsden O, Clery P, dArch Smith S, Leedham-Green Ket al., 2021, Sustainability in Quality Improvement (SusQI): challenges and strategies for translating undergraduate learning into clinical practice, BMC Medical Education, Vol: 21, Pages: 1-11, ISSN: 1472-6920

BackgroundThe healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges.MethodsWe conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual framework. We then combined our findings with behaviour change theory to generate educational recommendations.ResultsStudents that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role.ConclusionsWe present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.

Journal article

Day G, Robert G, Leedham-Green K, Rafferty AMet al., 2021, An outbreak of appreciation: A discursive analysis of tweets of gratitude expressed to the National Health Service at the outset of the COVID-19 pandemic., Health Expectations, ISSN: 1369-6513

BACKGROUND: The early stages of the coronavirus disease 2019 pandemic prompted unprecedented displays of gratitude to healthcare workers. In the United Kingdom, gratitude was a hotly debated topic in public discourse, catalysing compelling displays of civic togetherness but also attracting criticism for being an unhelpful distraction that authorized unrealistic expectations of healthcare workers. Expressions of thanks tend to be neglected as drivers of transformation, and yet, they are important indicators of qualities to which people attach significance. OBJECTIVE: This study aimed to use discursive analysis to explore how the National Health Service (NHS) was constructed in attention-attracting tweets that expressed and/or discussed gratitude to the NHS. METHODS: Having determined that Twitter was the most active site for traffic relating to gratitude and the NHS, we established a corpus of 834 most-liked tweets, purposively sampled from Twitter searches on a day-by-day basis over the period of the first lockdown in the United Kingdom (22 March-28 May 2020). We developed a typology for tweets engaging with gratitude as well as analysing what the NHS was thanked for. RESULTS: Our analysis, informed by a discursive psychology approach, found that the meanings attributed to gratitude were highly mobile and there were distinct patterns of activity. The NHS was predominantly-and sometimes idealistically-thanked for working, effort, saving and caring. Displays of gratitude were seen as incommensurable with failures of responsibility. The clap-for-carers campaign was a potent driver of affect, especially in the early parts of the lockdown. CONCLUSIONS: The social value of gratitude is implicated in the re-evaluation of the risks and rewards of healthcare and social care work in the wake of the pandemic. We caution against cynicism about gratitude overshadowing the well-being effects that expressing and receiving gratitude can engender, particularly given concerns over th

Journal article

Buckeldee O, Morrice R, Leedham-Green K, 2021, Perspectives of clinical teaching fellows on preparedness for practice: a mixed-methods exploration of what needs to change, Medical Education Online: an electronic journal, Vol: 26, Pages: 1-13, ISSN: 1087-2981

BackgroundSupporting medical students in their transition to newly qualified doctor is an important educationalpriority. Clinical Teaching Fellows (CTFs), as both recent graduates and trained educators, are uniquelypositioned to suggest curricular enhancements to support preparedness for practice.MethodsOur mixed-methods approach involved CTFs across eight UK teaching hospitals. We conducted fiveactivity-oriented focus groups to explore what CTFs felt needed to change to increase preparednessfor practice. We analysed these focus groups to create a dataset of their suggestions followed by asurvey. The survey invited CTFs to rate and rank these suggestions in relation to their own self-ratedpreparedness for practice, with qualitative insights into their choices. We explored commonalities anddifferences between high and low confidence participants, with findings qualitatively illuminated.Results24 CTFs attended focus groups from which we identified 28 curriculum items and 10 curriculumagendas. We collected 23 complete survey responses. All confidence groups rated communicatingwith colleagues and managing working life as unmet needs, whereas core clinical competencies suchas history and examination were well met. Participants with low confidence identified more complexclinical competencies including clinical decision making, task prioritisation and end-of-life care asunmet needs, with decision making and prioritisation being the most important. Confident graduatesrated higher professional competencies such as quality improvement, career planning and educationas unmet needs but of low importance. Graded transition of responsibility was the highest rankedcurriculum agenda. Qualitative insights included suggestions for how learning in clinical environmentscould be enhanced.ConclusionsOur findings suggest that transitioning from student to newly qualified doctor could be supported bygraded entrustment and enhanced shadowing opportunities. Other recommendations includepriori

Journal article

Clery P, D'Arch Smith S, Marsden O, Leedham-Green Ket al., 2021, Sustainability in quality improvement (SusQI): a case-study in undergraduate medical education, BMC Medical Education, Vol: 21, Pages: 1-13, ISSN: 1472-6920

BackgroundThere is a pressing need for more sustainable healthcare. UK medical graduates are required to apply social, economic, and environmental principles of sustainability to their practice. The Centre for Sustainable Healthcare has developed a sustainability in quality improvement (SusQI) framework and educator’s toolkit to address these challenges. We aimed to develop and evaluate SusQI teaching using this toolkit at Bristol Medical School.MethodsWe facilitated a SusQI workshop for all third-year Bristol Medical School students. We used mixed methods including questionnaires, exit interviews and follow-up focus groups to evaluate the outcomes and processes of learning.ResultsStudents reported: improvements in knowledge, confidence, and attitudes in both sustainable healthcare and quality improvement; increased self-rated likelihood to engage in SusQI projects; and willingness to change practices to reduce environmental impact in their healthcare roles. Factors for successful teaching included: interactivity; collaboration and participation; and real-life, relevant and tangible examples of projects delivered by credible role models.ConclusionsStudents reported that SusQI education supported by the toolkit was effective at building knowledge and skills, and reframed their thinking on sustainability in quality improvement. Combining the two topics provided enhanced motivation for and engagement in both. Further research is needed on the clinical impacts of SusQI learning.

Journal article

Mitchell O, Cotton N, LeedhamGreen K, Elias S, Bartholomew Bet al., 2021, Video‐assisted reflection: improving OSCE feedback, The Clinical Teacher, Vol: 18, Pages: 409-416, ISSN: 1743-4971

BackgroundObjective Structured Clinical Examinations (OSCEs) are commonly used to provide feedback to students on their performance in formative examinations. However, students are often unable to act independently on the feedback they receive. This study explored how the use of video‐assisted reflection in OSCEs can enhance students’ ability to reflect and engage in sustainable feedback.MethodsTwenty‐one students undertaking a mock‐final OSCE consented to have one of their examination stations filmed. Participants completed a series of reflective forms immediately after the OSCE, after verbal feedback from an examiner and finally, after watching the video of their own performance. Students were asked to predict their overall grade as well as list areas for improvement. Pearson r correlations examined the relationship between the examiners’ grades and the candidates’ self‐predicted grades. Wilcoxon signed‐rank tests were used to compare the length of reflections at each stage. Semi‐structured interviews were conducted to explore students’ beliefs on self‐efficacy and how the video‐assisted reflection altered their ability to act on feedback.ResultsThe students’ ability to self‐assess and gauge their own performance improved significantly after undertaking the video‐assisted reflection (p < 0.01). Furthermore, video‐assisted reflection significantly increased the length of the student's reflections.In interviews, participants described multiple ways in which the video‐assisted reflection improved their confidence and ability to act on feedback, highlighting a clear enhancement in self‐efficacy.DiscussionVideo‐assisted reflection of recorded OSCE stations represents an effective approach to increase student self‐efficacy and subsequently improve engagement in sustainable feedback practice.

Journal article

Lee A, Abdulhussein D, Fallaha M, Buckeldee O, Morrice R, Leedham-Green Ket al., 2021, Whole consultation simulation in undergraduate surgical education: a breast clinic case study, BMC Medical Education, Vol: 21, Pages: 1-12, ISSN: 1472-6920

Background: Safe and effective clinical outcomes (SECO) clinics enable medical students to integrate clinical knowledge and skills within simulated environments. This realistic format may better prepare students for clinical practice. We aimed to evaluate how simulated surgical clinics based on the SECO framework aligned with students’ educational priorities in comparison with didactic tutorials.Methods: We delivered two breast surgery SECO-based simulated clinics to Year 3 students during their surgical attachments at a London teaching hospital. All students attended a didactic breast surgery tutorial the previous week. Pre- and post-session surveys and post-session debriefs were used to explore learning gain, processes, preferences and impacts on motivation to learn. Data were analysed using inductive thematic analysis to categorise student views into themes. Results: 17 students enrolled in the simulated clinics and debriefs. Students expressed that passing examinations was a key extrinsic motivating factor, although the SECO-based format appeared to shift their motivation for learning towards aspiring to be clinically competent. Self-reported confidence in clinical skills such as history taking and examination improved significantly. Active learning methods were valued. Students expressed a preference for simulated clinics to complement, but not replace, tutorial-based learning. Conclusion: The SECO-based simulated clinic promoted a shift towards intrinsic motivation for learning by allowing students to recognise the importance of preparing for clinical practice in addition to passing examinations. Integration of surgical simulated clinics into the undergraduate curriculum could facilitate acquisition of clinical skills through active learning, a method highly valued by students.

Journal article

Leedham-Green K, Knight A, Reedy G, 2021, Success and limiting factors in health service innovation: a theory generating mixed-methods evaluation of UK projects, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives: To explore and explain success and limiting factors in UK health service innovation.Design: Mixed methods evaluation of a series of health service innovations involving a survey and interviews, with theory-generating analysis.Setting: The research explored innovations supported by one of the UK’s Academic Health Science Networks which provides small grants, awards and structural support to health service innovators including clinical academics, health and social care professionals and third-sector organisations.Participants: All recipients of funding or support 2014–2018 were invited to participate. We analysed survey responses relating to 56 innovation projects.Results: Responses were used to conceptualise success along two axes: value creation for the intended beneficiaries and expansion beyond its original pilot. An analysis of variance between categories of success indicated that participation, motivation and evaluation were critical to value generation; organisational, educational and administrative support were critical to expansion; and leadership and collaborative expertise were critical to both value creation and expansion. Additional limiting factors derived from qualitative responses included difficulties navigating the boundaries and intersections between organisations, professions, sectors and cultures; a lack of support for innovation beyond the start-up phase; a lack of protected time; and staff burn-out and turnover.Conclusions: A nested hierarchy of innovation needs has been derived via an analysis of these factors, providing targeted suggestions to enhance the success of future innovations.Data availability statementData are available upon reasonable request. Due to the highly individual nature of healthcare innovations and the limited geographic area of this study, we are unable to provide our raw data. We undertake to provide a redacted data set upon reasonable request.

Journal article

Hunukumbure AD, Leedham-Green KE, Rajamanoharan A, Patel K, Tang A, Das Set al., 2021, Twelve tips for surgeons to maximise medical student learning in the operating theatre, Medical Teacher, Pages: 1-6, ISSN: 0142-159X

Theatre-based learning is an essential component of undergraduate surgical education and offers a wide range of learning opportunities. However, studies have demonstrated that medical students have not always benefited from this holistic learning environment due to many reasons, including intimidation, hierarchies within the surgical environment and fear of making mistakes. The lead surgical educator's approach is an important influence on the experience and learning of their medical students. These twelve tips are aimed at surgical educators with undergraduate teaching responsibilities. This guidance is based upon evidence from literature and established theories of teaching and learning, supplemented by qualitative interviews with surgeons and medical students. The resulting tips were checked and refined by surgical teaching fellows. These learner-centred tips provide guidance on thorough induction, managing mutual expectations and approaches that optimise teaching and learning in the operating theatre. They are designed to support surgical educators in improving their students' engagement and learning experiences in this setting.

Journal article

Petrou L, Mittelman E, Osibona O, Panahi M, Harvey J, Patrick Y, Leedham-Green Ket al., 2021, The role of humanities in the medical curriculum: medical students' perspectives, BMC Medical Education, Vol: 21, ISSN: 1472-6920

BackgroundThe humanities have long been shown to play an important role in the medical school curriculum. However, few studies have looked into the opinions of medical students on the usefulness and necessity of the humanities as well as their extracurricular involvement with them. The aim of this study was to: a) understand medical students’ attitude towards the humanities in medical education and b) assess their understanding of the necessary qualities of doctors and how interaction with the humanities affects the development of such attributes. MethodsA mixed methods survey was designed to elicit demographics, engagement, interest and perspective on curricular positioning, and to explore how students ranked the qualities of a doctor. It was distributed to medical students of all year groups in the 6-year bachelor of medicine, bachelor of surgery (MBBS) course at Imperial College London. Results109 fully completed questionnaires were received. No significant difference was found in engagement or interest in the humanities between genders. Students felt strongly that humanities subjects shouldn’t be assessed (71:18) though some felt it was necessary for engagement, while no consensus was reached on whether these subjects should be elective or not (38:31). The majority of students wanted more medical humanities to be incorporated into the traditional medical course with a preference of incorporation into the first 3 years. Junior medical students were more likely to rank empathy as a highly desirable attribute than senior students. Students provided qualitative insights into curricular positioning, assessment and value.ConclusionsThis study provides the perspective of medical students on how and whether the humanities should be positioned in medical education. It may be helpful to medical schools that are committed to student involvement in curriculum design.

Journal article

Shaw E, Walpole S, McLean M, Alvarez-Nieto C, Barna S, Bazin K, Behrens G, Chase H, Duane B, El Omrani O, Elf M, Faerron Guzmán CA, Falceto de Barros E, Gibbs TJ, Groome J, Hackett F, Harden J, Hothersall EJ, Hourihane M, Huss NM, Ikiugu M, Joury E, Leedham-Green K, MacKenzie-Shalders K, Madden DL, McKimm J, Nayna Schwerdtle P, Peters S, Redvers N, Sheffield P, Singleton J, Tun S, Woollard Ret al., 2021, AMEE consensus statement: planetary health and education for sustainable healthcare., Medical Teacher, Vol: 43, Pages: 272-286, ISSN: 0142-159X

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet. The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals. This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in disc

Journal article

Horner P, Hunukumbure D, Fox J, LeedhamGreen Ket al., 2020, Outpatient learning perspectives at a UK hospital, The Clinical Teacher, Vol: 17, Pages: 680-687, ISSN: 1743-4971

BackgroundUndergraduate students spend much of their training in the clinical workplace, increasingly in hospital outpatient settings; however, they report that this does not always yield the educational value that they expect. This study investigates ways in which outpatient learning can be enhanced from the perspectives of students and teachers, exploring which approaches may be most appropriate in different circumstances.MethodsWe conducted 14 semi‐structured interviews with medical students from one UK medical school and consultants (specialists) at a single teaching hospital. We explored their experiences and perceptions of clinical teaching and learning in this outpatient setting. Transcripts were analysed through a consensual qualitative research approach. An evaluation of established frameworks for outpatient teaching was conducted and strategies were matched to stakeholder needs.FindingsA total of 24 core ideas were identified, which were categorised into: individual factors (student, doctor and patient), interpersonal factors, team factors and organisational factors. Teaching strategies that address stakeholder needs included: student‐led clinics, case‐based discussions, one‐minute preceptor, the SNAPPS tool (summarize, narrow differential, analyse, probe preceptor, plan and select issues for self‐learning), advanced organisers and supplementing.DiscussionThere is a complex interplay between personal, interpersonal, team and organisational factors that contribute to the effectiveness of the outpatient setting as a learning environment. Strategies at the personal and interpersonal levels are unlikely to be successful or sustained without organisational resourcing and support. Further research is needed to implement and evaluate these suggested strategies.

Journal article

Leedham-Green K, Knight A, Iedema R, Leedham-Green Ket al., 2020, Hierarchies and tribes: is it time to rethink professional identity formation in health professional education?, ASME Annual Scholarship Meeting 2020, Publisher: Wiley, Pages: 119-119, ISSN: 1743-4971

Hierarchies and tribes: is it time to reconsider professional identity formation in health professional education?BackgroundProfessional identity formation is a relatively new concept within medical education. The majority of literature has appeared since the Carnegie Foundation called for its inclusion into curricula on the 100th anniversary of the Flexner Report of 1910 [1]. This report called for faculty to hold students to high professional standards through role modelling and relationship building and suggested that curricula include symbolic rites of passage such as honour codes, pledges, and white coat ceremonies. Since then almost 200 articles have appeared in the medical education literature with a variety of stances and evolving interpretations which have yet to be interpreted through a critical lens.MethodsWe conducted a scoping review of the literature on professional identity formation, and meta-thematic synthesis of the most recent papers by the eight most cited authors. We discuss these in relation to key concepts and theories from the fields of critical theory, sociology, psychology and organisational scholarship. ResultsWe present themes and examples from the literature relating to diverse schools of thought on the purpose and process of professional identity formation, alongside a critical analysis of some of the current academic discourses and recommendations for educators. Deductive arguments are presented inline with our results.We question the educational benefits of espousing idealised professional identities, when the lived experience of learners includes needing to actively mitigate against professional tribes and witnessing the adverse effects of siloed working. We suggest that professional identity is an expression of hierarchy and power, particularly between professions and between those identifying as primary, secondary and community care professionals. Non-traditional students with different tangible social capital related to race, clas

Conference paper

Vassie C, Smith S, Leedham-Green K, 2020, Factors impacting on retention, success and equitable participation in clinical academic careers: A scoping review and meta-thematic synthesis, BMJ Open, Vol: 10, ISSN: 2044-6055

Objectives To examine and synthesise current evidence on the factors that affect recruitment, retention, participation and progression within the clinical academic pathway, focusing on equitable participation across protected characteristics including gender, ethnicity and sexual orientation.Design Scoping review and meta-thematic synthesis.Data sources Web of Science, Google Scholar.Article selection We conducted a scoping review of English language articles on factors affecting recruitment, retention, progression and equitable participation in clinical academic careers published in North America, Australasia and Western Europe between January 2005 and April 2019. The most recent and relevant 39 articles were selected for meta-thematic synthesis using detailed inclusion/exclusion criteria.Data extraction The articles were purposively sampled to cover protected characteristics and career stages and coded for factors related to equitable participation. 17 articles were fully coded. No new themes arose after nine papers. Themes and higher level categories were derived through an iterative consensual process.Results 13 discrete themes of factors impacting on equitable participation were identified including societal attitudes and expectations; national and organisational policies, priorities and resourcing; academic and clinical workplace cultures; supportive, discriminatory and compensatory interpersonal behaviours and personal factors related to social capital, finances, competing priorities, confidence and ambition, and orientation to clinical, academic and leadership roles.Conclusions The broad and often interconnected nature of these factors suggests that interventions will need to address structural and cultural factors as well as individual needs. In addition to standard good practice on equality and diversity, we suggest that organisations provide equitable support towards early publication success and targeted mentoring; address financial and role insecurity;

Journal article

Burridge S, Shanmugalingam T, Nawrozzadeh F, Leedham-Green K, Sharif Aet al., 2020, A qualitative analysis of junior doctors' journeys to preparedness in acute care, BMC Medical Education, Vol: 20, ISSN: 1472-6920

BackgroundNew doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time.MethodsWe conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise.ResultsMost participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences.ConclusionStarting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.

Journal article

Leedham-Green K, Knight A, Iedema R, 2020, Developing professional identity in health professional students, Clinical Education for the Health Professions, Editors: Nestel, Reedy, McKenna, Gough, Publisher: Springer Singapore, Pages: 1-21, ISBN: 9789811361067

Professional identity formation is a relatively new area of interest within health professional education, gaining academic attention after the Carnegie Foundation Report on Medical Education of 2010 called for its introduction into medical curricula in the United States. This chapter presents a critical discussion, introducing various schools of thought, and provides theoretically informed suggestions for practice. The authors explore both conventional identity formation and more complex modern reconfigurations of healthcare professional identity. The chapter starts with an overview of different stances on what professional identity means, drawing on a variety of literatures including sociological and organizational scholarship. Next, a range of theories of identity formation are presented, including socialization and transformation. A matrix model is introduced to inform curricular planning, which can be used flexibly within different institutions or contexts. The authors discuss and critique a number of focused strategies for educators including role modeling, mentoring, reflective practice, responding to the hidden curriculum, authentic role experiences and simulation-based education, communities of practice and activity theory, student engagement, and assessment practices. The chapter concludes with possible future directions in healthcare professional identity education. Kathleen Leedham-Green is a research fellow in the Medical Education Research Unit at Imperial College London with interests in the social and behavioral aspects of clinical practice as well as healthcare innovation and quality. Alec Knight is a postdoctoral researcher and educator at King’s College London with interests in health services research, applied psychology, medical education, public health, health policy, and implementation science. Rick Iedema is professor and director of the Centre for Team-Based Practice and Learning in Health Care at King’s College London.

Book chapter

Leedham-Green K, Iedema R, Knight A, 2019, Intra- and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences, BMC Medical Education, Vol: 19, ISSN: 1472-6920

BackgroundProfessional identities are influenced by experiences in the clinical workplace including socialisation processes that may be hidden from academic faculty and potentially divergent from formal curricula. With the current educational emphasis on complexity, preparedness for practice, patient safety and team-working it is necessary to evaluate and respond to what students are learning about collaborative practices during their clinical placements.Methods394 second year medical students at a London medical school were invited to submit a short formative essay as part of their coursework describing, evaluating and reflecting on their experiences of how healthcare professionals work together. Their experiences were derived from having spent two days each week for 25 weeks in clinical contexts across primary and secondary care. We consented 311 participants and used a Consensual Qualitative Research approach to analyse these essays, creating a ‘students-eye view’ of intra- and interprofessional practices in the workplace.ResultsWe identified four overarching themes in students’ essays: Theme 1: analyses of contextual factors driving team tensions including staff shortages, shifting teams, and infrastructural issues; Theme 2: observations of hierarchical and paternalistic attitudes and behaviours; Theme 3: respect for team members’ ability to manage and mitigate tensions and attitudes; and Theme 4: take-forward learning including enthusiasm for quality improvement and system change.ConclusionsStudents are being socialised into a complex, hierarchical, pressurised clinical workplace and experience wide variations in professional behaviours and practices. They articulate a need to find constructive ways forward in the interests of staff wellbeing and patient care. We present educational recommendations including providing safe reflective spaces, using students’ lived experience as raw material for syste

Journal article

Leedham-Green K, Wylie A, Ageridou A, Knight A, Smyrnakis Eet al., 2019, Brief intervention for obesity in primary care: how does student learning translate to the clinical context?, MedEdPublish, Vol: 8, Pages: 1-14, ISSN: 2312-7996

There is an international call for more sustainable approaches to healthcare and for graduating doctors to develop the competencies to address the behavioural, psychological and social determinants of health. Obesity is a global challenge, and the case for preventative health is evident. There is growing evidence to support brief interventions for obesity in primary care. The feasibility and acceptability of teaching within classroom contexts have been demonstrated, however there are known barriers to adopting these approaches with patients. It is unclear how well classroom learning translates to the clinical context. 329 final year medical students from Aristotle University of Thessaloniki attended training that had been developed through action research processes at King’s College London and adapted to the local context. Students conducted brief interventions with 3,177 overweight or obese patients across 136 primary healthcare facilities over three rotations. Their reflective learning essays were coded for content and thematically analysed to illuminate their experiences. Emergent themes include students’ insights into the drivers behind the obesity epidemic and psychosocial barriers to change; transformative experiences using patient-centred approaches to communication and behaviour change; progression in skills and attitudes to broaching obesity in clinical contexts; and insights into the factors that drive patient engagement. Their experiences indicate that facilitative approaches are acceptable to patients, and result in commitment to change where relevant to the patient’s agenda.

Journal article

Musaeus P, Wellbery C, Walpole S, Rother H-A, Vyas A, Leedham-Green KEet al., 2018, E-collaborating for environmentally sustainable health curricula, Climate Literacy and Innovations in Climate Change Education., Editors: Azeiteiro, Filho, Aires, Publisher: Springer, Pages: 151-167, ISBN: 9783319701981

PurposeThis chapter aims to demonstrate how medical educators can use e-collaborative tools to collaborating internationally and cross-institutionally towards designing environmental sustainability and health (ESH) education. The main focus of the chapter is on sustainable medical curricula.MethodologyThe chapter uses a case-study approach to bridge these broader e-collaborative principles with the specifics of implementation driven and supported by e-collaboration.FindingsThe case study describes the evolution of the Sustainable Healthcare Education (SHE)-network into a network collaborative. Finally, the chapter discusses e-collaboration for education development through an illustrative case. The case concerns an UK-Greek University e-collaboration aimed at combating obesity and promoting climate literacy.Research implicationsE-collaboration is central at all levels of the ESH curriculum design process from forming a network collaborative around the curriculum process, alignment of assessment and learning activities with objectives, discussing and agreeing on a vision to the actual implementation plan.Practical implicationsE-collaboration aids the curriculum design process such that people feel that their participation and interests are valued, as well as providing resources and input to resource stressed academics and institutions. E-collaboration is not an end in itself, but a means of enabling a global network collaborative to address an issue that suits this type of collaboration towards sustainable healthcare education.OriginalityThis chapter is inventive in showing how the promotion of climate literacy can be a component of a sustainable medical curriculum and how this process is facilitated with e-collaborative tools. The chapter demonstrates how health education should educate climate literate health professionals who are able to address and reduce public health impacts of climate change.

Book chapter

Walpole SC, Vyas A, Maxwell J, Canny BJ, Woollard R, Wellbery C, Leedham-Green KE, Musaeus P, Tufail-Hanif U, Pavao Patricio K, Rother H-Aet al., 2017, Building an environmentally accountable medical curriculum through international collaboration, Medical Teacher, Vol: 39, Pages: 1040-1050, ISSN: 0142-159X

Background: Global environmental change is associated with significant health threats. The medical profession can address this challenge through advocacy, health system adaptation and workforce preparedness. Stewardship of health systems with attention to their environmental impacts can contribute to mitigation of and adaptation to negative health impacts of environmental change. Medical schools have an integral role in training doctors who understand the interdependence of ecosystems and human health. Yet integrating environmental perspectives into busy medical curricula is not a simple task.Content: At the 2016 Association for Medical Education in Europe conference, medical educators, students and clinicians from six continents discussed these challenges in a participatory workshop. Here we reflect on emerging themes from the workshop and how to plan for curricular change. Firstly, we outline recent developments in environmental health and associated medical education. Secondly, we reflect on our process and outcomes during this innovative approach to international collaboration. Thirdly, we present learning objectives which cover core content for environmentally accountable medical curricula, developed through a reflective process of international collaboration integrating current literature and the workshop outcomes.Conclusions: International collaboration can bring together diverse perspectives and provide critical insights for the inclusion of environmental health into basic education for medical practitioners.

Journal article

Wylie A, Leedham-Green K, 2017, Health promotion in medical education: lessons from a major undergraduate curriculum implementation, Education for Primary Care, Vol: 28, Pages: 325-333, ISSN: 1473-9879

Despite the economic, environmental and patient-related imperatives to prepare medical students to become health promoting doctors, health promotion remains relatively deprioritised in medical curricula. This paper uses an in-depth case study of a health promotion curriculum implementation at a large UK medical school to provide insights into the experiences of teachers and learners across a range of topics, pedagogies, and teaching & assessment modalities. Topics included smoking cessation, behavioural change approaches to obesity, exercise prescribing, social prescribing, maternal and child health, public and global health; with pedagogies ranging from e-learning to practice-based project work. Qualitative methods including focus groups, analysis of reflective learning submissions, and evaluation data are used to illuminate motivations, frustrations, practicalities, successes and limiting factors. Over this three year implementation, a range of challenges have been highlighted including: how adequately to prepare and support clinical teachers; the need to establish relevance and importance to strategic learners; the need for experiential learning in clinical environments to support classroom-based activities; and the need to rebalance competing aspects of the curriculum. Conclusions are drawn about heterogeneous deep learning over standardised surface learning, and the impacts, both positive and negative, of different assessment modalities on these types of learning.

Journal article

Wylie A, Leedham-Green KE, 2017, Piloting quality improvement projects in undergraduate medical education, Medical Education, Vol: 51, Pages: 543-544, ISSN: 0308-0110

Journal article

Chourdakis M, Smyrnakis E, Doundoulakis I, Leedham-Green KE, Wylie A, Benos A, Stephenson Aet al., 2016, Degree of motivation and perception of targeted weight loss among overweightand obese patients in primary care during a novel behavioral change consultation, 38th ESPEN Congress, Publisher: Elsevier, Pages: S228-S228, ISSN: 0261-5614

Conference paper

Leedham-Green KE, Pound R, Wylie A, 2016, Enabling tomorrow's doctors to address obesity in a GP consultation: an action research project., Education for Primary Care, Vol: 27, Pages: 455-461, ISSN: 1473-9879

Obesity is a leading risk factor for morbidity and mortality, however, guidelines for prevention and management are relatively recently established. Little is known about what needs to be in place to put these into practice. This research provides an insight into how senior medical students consult with obese patients in general practice, the range of their learning needs, and the impact of various educational strategies that aim to bring their practice closer to current evidence-based guidelines. It centres on a series of compulsory but formative reflective case studies written by final year students at one large medical school on their GP rotation as they consult independently with obese patients with 'next room' GP tutor support. Analysis of these case studies was used to inform a three-year educational action research project. By systematically identifying and addressing learning needs, including barriers and enablers to best practice, we have demonstrated how senior medical students, and their GP tutors, can acquire the role legitimacy and role competency required for effective practice.

Journal article

Leedham-Green KE, Smyrnakis E, Wylie A, Chourdakis M, Stephenson A, Benos Aet al., 2016, Breaking down the barriers to international collaboration through technology., Education for Primary Care, Vol: 27, Pages: 431-431, ISSN: 1473-9879

Journal article

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