Congratulations to Dr Gillian Vance, Dr Bryan Burford, Dr Charlotte Rothwell (SME) and Fiona Beyer and Dr Louise Tanner (IHS) who have been  commissioned by the General Medical Council to carry out a project to identify ‘Best Practice in Assessing Competence’.

What the project will do, and why it matters.
The GMC is the independent regulator of all doctors in the UK, and has various roles in relation to assessment, including one-off summative assessments. In this study, we will conduct a systematic literature review, supplemented by a number of case studies, to explore and synthesise evidence for good practice approaches to the summative assessment of doctors’ professionalism, ethical and safe practice, and use of simulated environments to assess clinical and professional competence.

The project’s outputs will support the GMC’s roles in assessment, and inform the regulator’s wider assessment strategy, including development of the new ‘Medical Licensing Assessment (MLA)’. The MLA is anticipated to complement the current quality assurance arrangements for undergraduate education and to replace the current ‘PLAB’ test for International Medical Graduates seeking to practise in the UK.

Talking about this commission Gill Vance, PI said:

“We are delighted that our research can help shape this significant development in the regulation of medical education in the UK.”

Background: Over a billion people, 15% of the world’s population, live with a disability (WHO, 2016). People with disabilities have poor oral health, high levels of unmet need and often limited access to oral health care facilities (Coyle et al., 2004; Ahmad et al., 2015). The dental profession has a social responsibility to provide equitable oral health care for all and this is recognised in the General Dental Council  document ‘Preparing for Practice’, which states “ registrants must be able to recognise the needs of all patients, including those with special care requirements”. This raises the question, are we adequately preparing future dental professionals to fulfil their obligations.

Understanding how students view the phenomena from an educational and social perspective, considering the interplay between these factors during their professional development as they prepare for clinical practice, led to the specific research questions.

Aim: To explore final year dental students’ insight into issues of disability, in order to inform the undergraduate Special Care Dentistry programme.

Research Questions
1. What are students’ perceptions of their preparedness to meet the needs of patients with disabilities?

2. What has influenced this sense of preparedness?

Method: Using a broadly phenomenological approach, two focus groups were employed to address the research questions. Sixteen final year dental students, attending Newcastle School of Dental Sciences participated. The recorded discussions were transcribed and analysed using thematic analysis, as described by Braun and Clark (2006).

Results:
In relation to the research questions, there was a noticeable variation in students’ perceptions relating to their preparedness. This variation appeared to be related to several influencing factors which can be linked to the emergent themes from the focus group discussions, namely; ‘Perceptions about disability’, ‘Experience of Disability’, ‘Patient Management’ and ‘Teaching and Learning’. These themes are not independent of each other; elements of each will be drawn upon and woven together during the formative years from undergraduate to practicing clinician, influencing the extent of self-efficacy beliefs and how prepared students feel about meeting the needs of those with disabilities. For example, perceptions will be influenced by experience, both from a social context and clinical and educational perspective. Clinical experience itself will be related to patient management and the teaching and learning element of their undergraduate education.

Conclusion:
The results of the study resonate with the majority of the literature, in that students reported different levels of experience and knowledge of disability and varying degrees of preparedness and self-efficacy in meeting patients’ needs. Closely aligned to Banduras theory of Self-efficacy (Bandura, 1994) which considers ‘mastery experience’ to be the most powerful influence of efficacy beliefs, students who had encountered people with disabilities at a social level, through volunteering, family or friends, had a strong sense of self-efficacy; added to this, if clinical exposure was reported, students again felt more comfortable dealing with this patient group. All agreed that the benefits of social and or clinical interaction with the disabled community would greatly enhance their professional development.

Drawing on the literature and outcomes of the study, as emphasised by Goss (2007), there is a need to nurture positive attitudes towards those with disabilities to reduce social factors contributing to health inequalities. It is therefore imperative the dental profession focus on providing appropriate education, including exposure to people with disabilities, at undergraduate and post-graduate level.

Project team: Dr Kathy Wilson (Dept of Sedation), Dr Richard Holmes (Dental Public Health), Miss Kate Bird (5th Year BDS), Dr Laura Delgaty (SME)

References
Ahmad, M.S., Razak, I.A. and Borromeo, G.L. (2015) ‘Special needs dentistry: perception, attitudes and educational experience of Malaysian dental students’, Eur J Dent Educ, 19(1), pp. 44-52.

Bandura, A. (1994) Self Efficacy. Available at: www.uky.edu/~eushe2/Bandura/Banency.html.

Braun, V. and Clarke, V. (2006) ‘Using thematic analysis in psychology’, Qualitative Research Psychology, 3, pp. 77-101.

Coyle, C., Saunderson, W. and Freeman, R. (2004) ‘Dental students, social policy students and learning disability: do differing attitudes exist?’, Eur J Dent Educ, 8(3), pp. 133-9.

Goss, N. (2007) ‘What do we mean by disability and equality in oral health? Editorial’, Journal of Disability and Oral Health, 8(3).

WHO (2016) 10 Facts on Disability. Available at: http://www.who.int/features/factfiles/disability/facts/en/{Accessed

The MBBS programme is currently undergoing the first major curriculum review for 18 years. A major part of this is to enhance the professional development of medical students with a major focus on developing resilience and maintaining compassion and empathy. We are keen to develop this, and other themes, using an evidence based approach through developing and adapting effective strategies that are being used in other institutions.

To this end, we held a symposium on resilience in February in which the evidence was explored and “tasters” in specific techniques were demonstrated. We were particularly keen to explore how the medical school in Cardiff have developed this strand in their curriculum both in terms of a deeper understanding of the principles but also in terms of their practical implementation. Cardiff was a particularly appropriate model for us to develop as they are leading thinkers in this area and are a medical school of similar size and reputation to Newcastle.

The ERDP Development Grant proposal was for a small team from the MBBS programme to visit Cardiff University at the invitation of Professor Debbie Cohen in order to understand the pedagogy and the practicalities of adapting their model to our own curriculum. In addition provisional thoughts about collaborative pedagogic research in this area, to include internationalisation through NUMed would be developed.

Key principles taken from the visit. 

Colleagues at Cardiff identified the importance of badging issues around resilience smartly in order to improve student engagement, for example instead of resilience, they use the word emotional intelligence, and for reflection, they used the word “change story”.   They also emphasized the need to find exciting ways to make some of these concepts more real and to strive for authenticity in the teaching.   They use near peer experiences to engage the students, for example, they used foundation year and core trainees for teaching notions of resilience to third year students.

Another key theme that Cardiff emphasise is the need to focus on positive emotions and focus on achievements and the positive attributes that protect against some of the stresses of being a medical student and a foundation year doctor.   There was mutual recognition from colleagues in  Cardiff and the visitors from Newcastle, that work environment is key and that understanding and having had experience of working within the environments in which students train and junior doctors work is central to supporting well-being.

In terms of Cardiff’s approach to resilience teaching and training, they did not feel that it should be mandatory but if it was, it would be more appropriate towards the end of the course in preparing the students for entry into the workplace.   With regard to measurements of resilience, the consensus was that these needed to be multiple in order to be robust  and that various tools were available,  however the overriding imperative was to decide what one  wanted to get out of the particular tool that you chose and why.

Embedding resilience into the new curriculum

In year 1 the team identified the need to develop a didactic session entitled ‘Becoming a doctor’ which introduced notions of professional identity formation, the hidden curriculum and resilience. Linked to the didactic session would be a seminar looking at self-awareness, one’s  values and possible clashes with the values of the profession  through the use of interactive  activities designed to engage the students and to  open their perspective around who they are and their journey to being doctors. Embedding notions of self-care within the academic mentorship role was also identified as another achievable outcome.  The establishment of mental health first aid training was proposed, possibly linking this with a tool kit in dealing with the stress of sitting a first OSCE type examination.

In terms of year 2 linking teaching of the neurobiology of stress to notions of resilience was discussed, possibly with a linked seminar to explore this further.   Also within year 2, the end of year transition course in the new curriculum could be developed to improve notions of listening and dealing with emotions prior to the student becoming more embedded in the clinical environment.

In year 3 staff development around mentoring,  role modelling,  and using key aspects of Schwartz and Balint style approaches were thought to be important. The use of a weekly seminar session in semester 1 to provide a space for reflection was seen as a key area to use some of these skills.  Also identified in year 3 for was the scope for integrated days in semester 2 where generic issues across rotations could be discussed.   Adolescent health has been suggested as a potential topic and this would both be a useful learning tool around their development as doctors but would also resonate in terms of their own self-care.

In year 4 the emphasis would be on inter and intra- professionalism and getting along with others, with looking to develop skills in dealing with conflict and managing uncertainty.  Also in year 4 there are plans to use longitudinal clinical placements, the evidence suggests that this would reduce empathy erosion and through embedding students in teams does much to support professional identify and improve resilience.

Year 5 would revisit some of the notions that were introduced in year 1 such as the hidden curriculum and role models. Considering both these concepts though areas such as human factors and the use of simulation would allow student  develop a better understanding of how these issues could affect both one personally and be related to patient safety.  In addition, educational supervision in year 5 would review reflections within a portfolio.  Revisiting self-care and resilience through near-peer experiences would be appropriate.  This is to some extent this is already been developed within the current PDS 6 course.

Finally with  regard to research,  the team concluded that getting some baseline data using a mix methodology approach comparing notions of resilience though different cultural perspectives and what constitutes good role models across cultures would be a good starting point.

Dr Stephen Jones, Director of Studies
Dr Dominic Johnson, Professionalism Lead
Dr David Kennedy, Degree programme Director

In July 2017 I attended a teaching health economics workshop which was part of the biannual conference of the International Health Economics Association in Boston, USA. This was funded via an ERDP Development Grant.

At the conference I presented some findings around ‘Engaging Distance Learners with No Economic Background in an Online Health Economics Course’ from an online module that I teach ONC8021 which is part of the MSc in Oncology and Palliative Care.

Below is a brief summary of the presentation:

Background: Many students who decide to undertake a distance learning course need to balance their learning with jobs and other commitments.  This impacts on when and how they engage with online materials.

Aims: This presentation will outline two methods for engaging health professionals with no previous economics experience enrolled in an online health economics module as part of a Master’s programme in Oncology and Palliative Care.

Methods: Many of the students would access the material in chunks to fit around their busy schedules rather than on a weekly basis as per the layout of the course.  This meant that discussion boards were not a useful tool to foster engagement.  To create a collaborative learning environment that fit in with the needs of the students, I developed a wiki exercise and sequential group work.

Results: The economic evaluation wiki exercise allowed students to contribute to completing a basic example of an economic evaluation of comparing four different methods for screening for colon cancer when their schedule permitted.  The health care market group work gave each individual two weeks to complete their part in identifying market failure in the market for health and offering solutions to overcome these failures.  Students were able to engage with their classmates by discussing the material and submitting an assignment at the end of the 6 week group exercise whilst still having a flexible timeframe for their learning.

Conclusion: Alternative methods of engagement to discussion boards are successful for health care professionals taking an online health economics module.

Practice Points:

• Different engagement strategies are required for distant learners
• Effective engagement using alternative methods for online students improved student performance and feedback
• All material and methods for group work cannot necessarily be transferred directly from a classroom to an online environment

From this presentation I have become involved in the Teaching Health Economics Special Interest Group which is part of the International Health Economics Association.  The aim of this group is to provide a mechanism for developing a global community of health economics educators that would collaborate to promote quality health economics training and to support one another in this endeavor.

Thanks to this ERDP funding I was able to help network at an international level and become a part of a community promoting best practice at the global level.

Dr Heather Brown, IHS