Publications
25 results found
Bull S, Coster S, Scott K, et al., 2024, GP trainees as teachers: a rapid review of the barriers, facilitators and outcomes., Educ Prim Care, Pages: 1-16
BACKGROUND: There is a workforce crisis in General Practice (GP) within the United Kingdom (UK). High-quality clinical placement experiences in GP influence medical students' interest and likelihood to enter this speciality. GP trainees often express a desire to teach, yet teaching does not feature significantly within their current practice. This study aims to explore outcomes, barriers, and facilitators of GP trainees teaching medical students through a rapid review of published literature. METHODS: MEDLINE, EMBASE, PsychINFO, Web of Science were searched for articles relating to GP trainees teaching. Studies conducted in the UK and Australia, between January 2000 and October 2022 were included. The Medical Education Research Study Quality Index and the Critical Appraisal Skills Programme checklist were used to assess quality. RESULTS: Twenty-seven publications, 11 qualitative, six quantitative, three mixed-methods and seven opinion pieces, were identified. Many studies have methodological limitations. Empirical studies show that there are benefits of near-peer teaching, but these are limited by trainees' capacity and capability to teach, and GPs' confidence in trainees' teaching. The culture within the practice influenced whether trainees were seen solely as learners or also as teachers for students. DISCUSSION: When GP trainees teach there are positive outcomes for medical students and trainees. Teaching was considered an activity that trainees did in 'addition to' rather than 'part' of' their training. Appropriate teaching opportunities, and relevant training, were key to trainees' competence and confidence in teaching. Resources and recognition and a strong teaching culture are needed to support GP trainees to teach.
Ikhlaq H, Agarwal S, Kwok C, et al., 2023, Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the United Kingdom, BMJ Open, Vol: 13, ISSN: 2044-6055
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.
Brown M, Ahuja N, Sivam V, et al., 2023, A qualitative evaluation of the impact of a medical student school outreach project on both medical students and school pupils, BMJ Open, Vol: 13, ISSN: 2044-6055
Objective To explore medical student and school pupil experiences of an outreach school teaching projectSettingCommunity engagement is increasingly commonplace within medical school. Secondary schools offer ample opportunities for community engagement, as medical students teach and engage in service learning. There is a lack of research regarding the impact of school community engagement projects and the impact on pupils, as critical stakeholders in the service medical students provide. In this qualitative study, we set out to explore the perspectives of medical students and school pupils involved in a school teaching project.Participants10 medical students participated in individual interviews, and 17 school pupils across three schools participated in group interviews. Data were analysed using thematic analysis, and the concept of service learning. Results For medical students, the project fostered communication and teaching skills, but a lack of reflection hampered further benefit. For school pupils, experiences varied – learning about careers in medicine could be inspiring, but content pitched at the incorrect level disengaged some pupils. Conflict between session timing and medical students’ exams negatively influenced engagement. ConclusionsTo shift the focus of community engagement projects which promote service-learning towards mutual benefit, designing in partnership with relevant community stakeholders and integrating opportunities for reflection on these experiences are critical. Strengths and Limitations of this study• To the authors’ best knowledge, this is the first study exploring the impact of a medical student school outreach project from school pupil perspectives.• This study offers rich qualitative data across stakeholder perspectives. • The theoretical framework of service learning used, casts new light on the ways in which school outreach projects influence learning. • The impact is limited by unanticipated
Danquah A, Bull S, Parekh R, 2023, Presenting and responding to the keynote plenary ‘Pigeonholes and Johari Windows’, The Clinical Teacher, Vol: 20, ISSN: 1743-4971
Brown M, Parekh R, Collin V, et al., 2023, 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, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055
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 repre
Sivam V, Brown M, Ahuja N, et al., 2023, The future integrated care workforce, The Clinical Teacher, Vol: 20, ISSN: 1743-4971
Harding D, Uppal S, Meiring S, et al., 2023, Community-engaged primary care medical education, The Clinical Teacher, Vol: 20, Pages: 1-5, ISSN: 1743-4971
BACKGROUND: Community-engaged medical education (CEME) requires medical schools to partner with local communities to help address community priorities, whilst enhancing the learning experiences of students. Current literature on CEME has focused on evaluating its effects on students; however, there remains a gap in exploring whether CEME initiatives can have a sustainable impact for communities. APPROACH: The Community Action Project (CAP) at Imperial College London, is an eight-week, community-engaged, quality improvement project for Year 3 medical students. Students initially consult with clinicians, patients and wider community stakeholders to understand local needs and assets, and identify a health priority to address. They then work with relevant stakeholders to design, implement and evaluate a project to help address their identified priority. EVALUATION: All CAPs (n = 264) completed in the 2019-2021 academic years were evaluated for evidence of several key areas, including community engagement and sustainability. 91% of projects evidenced a needs analysis, 71% demonstrated patient involvement in their development, and 64% demonstrated sustainable impacts from their projects. Analysis revealed the topics frequently addressed, and the formats used by students. Two CAPs are described in more detail to demonstrate their community impact. IMPLICATIONS: The CAP demonstrates how the principles of CEME (meaningful community engagement and social accountability) can lead to sustainable benefits for local communities through purposeful collaboration with patients and local communities. Strengths, limitations and future directions are highlighted.
Brown ME, Collin V, Parekh R, et al., 2023, A contextual definition of longitudinal integrated clerkships within the UK and Ireland: a bi-national modified Delphi study, Education for Primary Care, Vol: 34, Pages: 138-151, ISSN: 1367-8523
Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.
Shemtob L, Parekh R, Majeed A GP, 2023, Changes to the GP contract do not add up, BMJ: British Medical Journal, Vol: 381, Pages: 770-770, ISSN: 0959-535X
Parekh R, Maini A, Golding B, et al., 2022, Community-engaged medical education: helping to address child health and social inequality, Archives of Disease in Childhood: Education and Practice Edition, Vol: 107, Pages: 397-401, ISSN: 1743-0585
Medical education has a key role in helping to address child health and social inequality. In this paper we describe the rationale for developing a community-engaged approach to education, whereby medical schools partner with local communities. This symbiotic relationship enables medical students to experience authentic learning through working with communities to address local health and social priorities. Case studies of how such approaches have been implemented are described, with key takeaway points for paediatric healthcare professionals wanting to develop community-engaged educational initiatives.
Coster S, Parekh R, Moula Z, et al., 2022, Responsibility driven learning in primary care: a qualitative evaluation of a medical student COVID-19 volunteering programme, BMC Medical Education, Vol: 22, Pages: 1-8, ISSN: 1472-6920
Background: During the first wave of the pandemic when clinical placements were suspended, a UK medical student volunteering programme was developed to support local GP practices. This study aimed to explore the impact that volunteering in primary care had on students’ learning and professional development to inform the design of future service-learning curricula innovations.Methods: Seventy medical students across all years volunteered across forty-five GP practices in north-west London. Ten volunteer students and six GPs who had hosted students volunteered to participate in remotely conducted, semi-structured interviews with a researcher. Transcriptions were independently coded by two researchers and analysed by thematic analysis using service learning and communities of practice as sensitising concepts.Results: Analysis showed a strong alignment between the views of students and GPs in terms of perceived learning. Our analysis of both sets of interviews resulted in five themes describing student outcomes from the volunteering scheme: developing as a doctor, understanding the complexity of medicine, responsibility driven learning, a meaningful role in a community of practice, and seeing behind the scenes in primary care. Discussion and conclusions: Results from this study highlighted how a meaningful service-led role and responsibility in primary care can empower and motivate students to learn beyond the traditional medical curriculum and assessments. Adopting these new ‘pro-active’ roles within general practices led volunteers, particularly those in the early years of study, to develop a better understanding of primary care and medical complexity. It also enhanced their professional skills, attitudes and behaviours, while having a beneficial impact on patient care during the pandemic.
Brown MEL, Parekh R, Anderson K, et al., 2022, ‘It was the worst possible timing’: the response of UK Longitudinal Integrated Clerkships to Covid-19, Education for Primary Care, Vol: 33, Pages: 288-295, ISSN: 1367-8523
Covid-19 has altered medical education worldwide. Given recent events, UK Longitudinal Integrated Clerkships (LICs), which are relatively new innovations, may have changed in structure and delivery, or may have demonstrated resilience. Collating the responses and experiences of UK institutions may yield transferrable recommendations for institutions wishing to develop sustainable LICs. A mixed-methods survey concerning LIC prevalence, variety, and experiences of responses to Covid-19 was circulated to all 33 UK medical schools through academic networks. 25 survey responses were received, representing 20 institutions. 12 faculty completed follow up semi-structured interviews. 13 LICs were reported: 1 wasn’t running during 2020, 5 were running unchanged, and 7 with alterations. 2 additional LICs were planned. Thematic analysis of free-text survey and interview responses revealed that relationships between faculty and institutions were central in facilitating recent adaptations to UK LICs. Given model flexibility, an increased drive to develop LICs was also evident. Barriers to adapting programmes included uncertainty regarding progression of Covid-19 restrictions and issues with secondary care access. Investing in faculty development and support networks could increase LIC sustainability. By highlighting the relative resilience of UK LIC placements during Covid-19, these findings offer important insight for the future delivery of sustainable LICs within, and beyond, the UK.
Parekh R, Jones MM, Singh S, et al., 2021, Medical students’ experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries, BMJ Open, ISSN: 2044-6055
Pilling R, Mollaney J, Chandauka R, et al., 2021, “BURSTING THE BUBBLE”: Service learning in schools, The Clinical Teacher, Vol: 18, Pages: 163-167, ISSN: 1743-4971
BackgroundAt Imperial College, we developed a novel teaching programme for medical students based within a local primary school, with the aim of developing students’ teaching skills and centring social accountability in our curriculum. Similar service‐learning programmes have shown significant benefit for student participants, including: improving communication skills, developing an understanding of the social determinants of health, and increased empathy. In partnership with a local primary school, the programme involved a group of medical students designing, developing and delivering a teaching session to primary school children.MethodsMedical students completed written reflections on the programme and semi‐structured interviews were conducted with teachers who had participated in the programme. These were then thematically analysed.ResultsThemes from student reflections included: improvement in teaching and communication skills; and an increased awareness of social accountability. Themes from teacher interviews included: benefits of an aspirational figure in the school; engagement of the children; and the ongoing inspirational benefit for the pupils.DiscussionOur analysis suggested students and the school community benefitted. Students reported the experience was an effective way to learn teaching skills and to improve their communication with children. The programme delivered skills transferrable to other clinical contexts including leadership and behavioural management, adaptability and creative thinking. Teacher interviews suggested the programme was mutually beneficial. The framing of medical students as role models raised the possibility that such programmes may help tackle the challenge of widening participation in medicine. We would recommend medical educators to consider developing other mutually beneficial service‐learning programmes.
Alboksmaty A, Kumar S, Parekh R, et al., 2021, Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK—Qualitative assessment, PLoS One, Vol: 16, Pages: 1-17, ISSN: 1932-6203
ObjectivesThe study aims to investigate GPs’ experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL).DesignThis is a service evaluation adopting a qualitative approach.SettingIndividual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact.ParticipantsFourteen GPs working in NWL were interviewed, until data saturation was reached.Outcome measuresThe impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs’ perspective.ResultsParticipants’ average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients’ behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs’ suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of “infodemic” to describe the GPs’ everyday pressure of receiving new policy updates with their subsequent changes in practice.ConclusionThe COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs’ perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should b
Hawkins N, Younan H-C, Fyfe M, et al., 2021, Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation, BMC Medical Education, Vol: 21, ISSN: 1472-6920
BackgroundCurrent research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training.Methods30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students’ clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes.ResultsSix key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning ‘on the job’.ConclusionsThe combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised withi
McKeown A, Mollaney J, Ahuja N, et al., 2019, UK longitudinal integrated clerkships: where are we now?, Education for Primary Care, Pages: 1-5, ISSN: 1473-9879
In this article, we discuss whether it is possible for UK institutions to influence the international longitudinal integrated clerkship (LIC) narrative, in the context of supplying future clinicians to a fragmented health service that is battling a General Practice recruitment crisis. Perhaps more importantly, we will discuss whether the ‘LIC model’ fits the UK undergraduate framework. We intend to present some emerging evidence of LICs in the UK, informed by a UK-wide survey and observations from a 2019 UK LIC think tank and then discuss whether the global CLIC definition applies to the UK context with possible ways forward.
Simpkin A, McKeown A, Parekh R, et al., 2019, Identifying central tenets needed in our education systems: results from a pilot integrated clinical apprenticeship, Medical Teacher, ISSN: 0142-159X
Purpose:The ability of healthcare systems to deliver world-class compassionate care depends on the quality of training and education of staff. Matching student-centered learning with patient-centered care is the focus for much curricula reform. This study explores the effect a novel longitudinal curriculum had on medical students’attitudes and experiences to better identify central tenets needed in our education system. Methods:Single-center, qualitative focus-group study conducted in 2017 of medical students in a longitudinally integrated clinical apprenticeship at a large UK medical school. Students were randomly assigned to focus groups to describe their educational journey and explore how longitudinal learning prepared them for a medical career, valuing their unique pos- ition as student participants in the healthcare system. Results:Four themes emerged from students’experiences: navigating the patient journey, their professional development, their learning journey, and the healthcare system. Conclusions:Listening to student voices lends insights for educators refining educational models to produce doctors of tomorrow. This project identified the educational value of students having authentic roles in helping patients navigate the healthcare system and the benefits of consistent mentorship and greater autonomy. The gulf between gaining skills as a future doctor and gaining skills to pass summative exams calls into question assessment methods.
Simpkin AL, McKeown AM, Parekh R, et al., 2017, A novel Integrated Clinical Apprenticeship: transforming medical students into student doctors, EDUCATION FOR PRIMARY CARE, Vol: 28, Pages: 288-290, ISSN: 1473-9879
McKeown A, Parekh R, 2017, Longitudinal integrated clerkships in the community, EDUCATION FOR PRIMARY CARE, Vol: 28, Pages: 185-187, ISSN: 1473-9879
McKay AJ, Parekh R, Majeed A, 2016, Implications of the imposition of the junior doctor contract in England, Journal of the Royal Society of Medicine, Vol: 109, Pages: 128-130, ISSN: 1758-1095
Parekh R, Fattah Z, Sahota D, et al., 2014, Clozapine induced tubulointerstitial nephritis in a patient with paranoid schizophrenia., BMJ Case Rep, Vol: 2014
We describe the development of tubulointerstitial nephritis after starting clozapine therapy in a patient with treatment-resistant schizophrenia. A 54-year-old mixed-race patient with a longstanding history of paranoid schizophrenia was started on the antipsychotic clozapine. Two months after starting clozapine he developed fevers, cough and acute renal failure which initially responded to 7 days of prednisolone but recurred after completing the steroid course. Renal biopsy confirmed acute tubulointerstitial nephritis and he was started on a course of steroids with renal recovery in 72 h. Clozapine was later stopped. This case highlights a serious and potential life-threatening complication of an important antipsychotic used in treatment-resistant schizophrenia.
Parekh R, Shah R, Darko D, et al., 2013, Brucellosis disguised as infective endocarditis in the returning traveller., JRSM Short Rep, Vol: 4, Pages: 1-3, ISSN: 2042-5333
Parekh R, Green E, Majeed A, 2012, Obstructive sleep apnoea: quantifying its association with obesity and snoring, PRIMARY CARE RESPIRATORY JOURNAL, Vol: 21, Pages: 361-362, ISSN: 1471-4418
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Parekh R, Beaconsfield T, Kong WM, 2012, A woman with neck pain and shortness of breath, BRITISH MEDICAL JOURNAL, Vol: 345, ISSN: 1756-1833
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