20 results found
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, ISSN: 2044-6055
Hunukumbure AD, Leedham-Green KE, Rajamanoharan A, et al., 2021, Twelve tips for surgeons to maximise medical student learning in the operating theatre, Medical Teacher, Pages: 1-6, ISSN: 0142-159X
Petrou L, Mittelman E, Osibona O, et al., 2021, The role of humanities in the medical curriculum: medical students' perspectives, BMC Medical Education, 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.
Shaw E, Walpole S, McLean M, et 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
Lee A, Abdulhussein D, Fallaha M, et al., 2021, Whole consultation simulation in undergraduate surgical education: A breast clinic case study, BMC Medical Education, ISSN: 1472-6920
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.
Leedham-Green K, Knight A, Iedema R, et 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 . 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
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;
Burridge S, Shanmugalingam T, Nawrozzadeh F, et 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.
Leedham-Green K, Knight A, Iedema R, 2020, Developing Professional Identity in Health Professional Students, Clinical Education for the Health Professions, Publisher: Springer Singapore, Pages: 1-21, ISBN: 9789811361067
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
Leedham-Green K, Wylie A, Ageridou A, et 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.
Musaeus P, Wellbery C, Walpole S, et 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.
Walpole SC, Vyas A, Maxwell J, et 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.
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.
Wylie A, Leedham-Green KE, 2017, Piloting quality improvement projects in undergraduate medical education, Medical Education, Vol: 51, Pages: 543-544, ISSN: 0308-0110
Chourdakis M, Smyrnakis E, Doundoulakis I, et 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
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.
Leedham-Green KE, Smyrnakis E, Wylie A, et al., 2016, Breaking down the barriers to international collaboration through technology., Education for Primary Care, Vol: 27, Pages: 431-431, ISSN: 1473-9879
Wylie A, Leedham-Green K, Tadeka Y, 2014, Engaging medical students and their teachers with the determinants of health: the approaches and impact of a curriculum development at one large UK medical school, MedEdPublish
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