British Medical Schools Research Articles

British Models of Person Centered Medicine

Background: The National Health Service (NHS) was established in 1948 as a publicly funded healthcare system in the UK providing universal health coverage that is comprehensive, equitable and free at the point of delivery. The British experience of person centered medicine (PCM) is enshrined in the NHS constitution. Objectives: The objective of this study was to highlight important developments in and evolution of PCM within the NHS in person-centered care (PCC), research and innovations in undergraduate and graduate health education. Methods: This is a narrative overview of the British experience of PCM. Results: It is evident that the British experience and practice of PCM have evolved naturistically over seven decades since the establishment of the NHS. Academic research groups in collaboration with the NHS have introduced person-centered models of care supported by pivotal research in practice. Importantly, person-centered nursing has been widely adopted following the early development of a framework for person-centered nursing and its extensive evaluation. There emerged many initiatives on PCM by National Voices, the Health Foundation, British medical schools and the Royal Medical Colleges. The landmark development was the production by the Royal College of Psychiatrists in the UK of the first blueprint for a postgraduate psychiatric curriculum that is in tune with person-centered psychiatry. Conclusions: It is envisaged that the NHS will evolve and increasingly promote, adopt, codesign and implement PCC approaches adapted to the local, regional and national contexts including services redesign, health education and applied health research. These innovations contribute to the universal development of person-centered healthcare and health education.

Gaston Labat, the Mayo Clinic, and the Introduction of Regional Anesthesia to the United States

Abstract Throughout the nineteenth century, transatlantic medical research and training was largely dominated by Western European hospitals. Americans trained in German, Austrian, French, and British medical schools and hospitals, and then returned to work in relatively subpar hospitals and medical schools in the U.S. This relationship was reversed after wwi, with European doctors seeking transition to a comparatively well-funded and respected medical community in the U.S. Recruited in 1920 from a French hospital system to the Mayo Clinic in Rochester, Minnesota, the young surgeon Gaston Labat (1897–1934) became a pioneer in the development of regional anesthesiology and pain management practices in America, establishing the Mayo Clinic as a leader in this nascent field. Published in the U.S. in 1922, Labat’s textbook Regional Anesthesia was based upon his earlier years of work in Paris and came to define the field over the subsequent decades. Labat moved to Bellevue Hospital in New York City, and in 1923 founded the American Society of Regional Anesthesia (asra). The asra acted as an engine of transformation in the professionalization of the field of anesthesia in the U.S. and formed part of the organized response to the opioid crises that emerged in the early twentieth century. Labat’s story serves as a window into this period of transition in global medical leadership and the introduction of regional anesthesiology and acute pain management, based upon European medical practice.

Remembering the Dead Poor in the Midlands, 1750s to 1880s

ABSTRACT The deaths of ordinary poor people are, in both the popular imagination and much of the historiography, indelibly linked with pauper funerals, mass graves, anatomization in British medical schools and the striking absence of any of the structures and symbols of remembrance (headstones, death notices, etc.) that we often associate with other classes in 18th and 19th-century England. The dead poor under the Old and New Poor Laws were not remembered except in the sense of leaving behind poor families that might require poor relief, poor children who needed apprenticing or a life story that had to be rehearsed by surviving family members so that their place of settlement could be determined in disputed relief cases. In 2005, Elizabeth Hurren and Steven King talked about the grave and the pauper body but not about the mourners, memorialization and the memory of the dead poor. For this article, a remarkable midland’s dataset has been used to argue that remembrance of the dead poor was more systematic, sustained and meaningful than the current literature allows.

618 A Registrar - Delivered Urology Experience Improves Medical Student Knowledge of the Subject and Increases Interest in a Surgical Career

Abstract Introduction Exposure to Urology is thought to vary considerably between medical schools, leading to a lack of competence by foundation doctors in basic urological skills and knowledge, and perhaps low interest in a urological / surgical career. In our hospital students had no dedicated Urology placement until 2020. Method A weeklong Urology placement was designed for 3rd year students. This comprised tutorials on topics set out by the university curriculum, a catheter insertion simulation session, and regular theatre and ward rounds. Most students also had the opportunity to insert a catheter on the ward / theatre. Students were encouraged to complete The National Catheter Education Programme, an online course providing a point for CST applications. This placement is registrar delivered, giving a more accurate idea of what a surgical career involves. Student feedback was obtained on the first and last days to ascertain self-rated confidence on a Likert-type scale regarding urological key topics, as well as career intentions. Results Self – rated knowledge on the 5 identified topics at the start of the week was most likely to be “Poor,” and by the end “Good” or “Very good.” By the end of the week most students indicated they were much more likely to pursue a career in surgery, although the same response was not seen as strongly for the subspeciality of Urology. Conclusions The placement continues to run and develop based on feedback. We look forward with interest to the publication of LEARN (uroLogical tEAching in bRitish medical schools Nationally) — a multicentre audit – to further inform this project.

Degenerative cervical myelopathy education in UK medical schools: a national cross-sectional survey of medical students

Introduction Degenerative cervical myelopathy (DCM) is a common and progressive neurological condition caused by injury of the cervical spinal cord by degenerative spinal pathology. Delayed diagnosis leading to avoidable and irreversible disability is a major current problem limiting patient outcomes. Lack of sufficient representation of DCM in undergraduate and postgraduate medical curricula may contribute to poor recognition of DCM by non-specialist doctors. The objective of this study was to assess the DCM teaching provision in UK medical schools and the DCM knowledge of UK medical students. Methods UK medical students completed a web-based survey distributed nationally through university social media pages, university email bulletins and the national student network of Myelopathy.org. The survey comprised a 19-item questionnaire capturing data on student demographics, myelopathy teaching and myelopathy knowledge. Advertisements were repeated monthly over a 12-month recruitment period and participation was incentivised by entry into an Amazon voucher prize draw. Ethical approval for the study was granted by the Psychology Research Ethics Committee, University of Cambridge (PRE.2018.099). Results A total of 751 medical students from 32 British medical schools completed the survey. Medical students from all year groups participated. Most students (520; 72%) had not received any medical school teaching about DCM. When students had received DCM teaching, the duration of teaching was minimal (75% < 1 h). A total of 350 students (47%) reported conducting private study on DCM. Modal student self-rating of their own knowledge of DCM was ‘terrible’ (356; 47%). There was no correlation between a student’s subjective rating of their knowledge and their answers to objective questions. A total of 723 (96%) of students expressed interest in learning more about DCM, with lectures the preferred format. Conclusions DCM appears to be a neglected condition in medical education which has implications for clinical practice. However, student enthusiasm to undertake private study suggests future teaching interventions will be well-received. Future work is necessary to characterise the format of DCM teaching that is most effective and to subsequently measure how educational interventions translate into clinical benefits.

A1063 - Evaluation of uroLogical tEAching in bRitish medical school Nationally: the LEARN multicentre cross-sectional study

A1063 - Evaluation of uroLogical tEAching in bRitish medical school Nationally: the LEARN multicentre cross-sectional study

Perception of Faculty of their Role as Medical Facilitator

Introduction: Over the past few decades integrated curricula has been presented in undergraduate medical education with an important point of producing competent doctors. In conventional teaching basic science subjects are taught in separation and no correlation exists between basic and clinical science subjects as well. British Medical School has been criticized within the report “Tomorrow’s Doctors: Suggestions on Undergraduate Medical Education”, for overburdening students with genuine information and recommendations emphasized that medical course ought to promote critical understanding of the core knowledge Health professions education is highly demanding and complex field. Integrated curriculum and modern instructional strategies demands the role of medical facilitator be revamp. These perceptions can be utilized to plan faculty development workshops to upgrade the mindfulness of the faculty about their educational responsibilities and accomplish their potential. Objective: To explore faculty perception regarding role of medical facilitator in a private sector medical college Material and Methods: Study design: Quantitative cross sectional Settings: Shahida Islam Medical &amp; Dental College Lodhran Duration: Six months i.e. July 2020 to December 2020 Data Collection procedure: It was quantitative cross sectional study conducted on a private sector medical college. Pre validated questionnaire was used to measure the perception of faculty members as facilitation of medical undergraduate students. Results: A total number of 40 faculty members filled the questionnaire. Eight items questionnaire was used after giving consent from faculty members. In this study of 40 participants, 22 were males and 18 were females. Regarding faculty perception of their roles as medical facilitators 95% shown as information provider, 89% as role model, as resource provider and facilitation in and outside the class both 88%, as leader 87%, curriculum developer 86% and researcher as 82%. The data was analyzed using SPSS version 24. Conclusion: The role of medical facilitator has extensive across the boundaries of information provider in facilitation of medical undergraduate students. The faculty of medical college shown their mindfulness about modern-day medical education and recognized the foremost important part of a medical facilitator to be not as it were an information provider but also an on-job role model and scholastic advisor to undergraduates. Key words: facilitator, faculty, perception, role model, medical

1160 LEARN (Urological Teaching in British Medical Schools Nationally): A Multicentre Cross-Sectional Study

Abstract Introduction Urology is a common rotation for UK Foundation Year (FY) doctors, and accounts for &amp;gt;25% of acute surgical referrals. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology to be covered during medical school. However, its national uptake remains unknown. LEARN aims to assess undergraduate urology teaching across UK medical schools. Method LEARN is the largest ever multicentre cross-sectional study of undergraduate urology teaching. Year 2-5 medical students and FY1 doctors were invited to complete a survey between 3rd October-20th December 2020. The primary objective is to compare current undergraduate urology teaching against the BAUS syllabus. Secondary objectives investigate the type and quantity of teaching provided, the reported performance rate of GMC mandated urological procedures, and the proportion of those considering urology as a career. Results A total of 7,611/8,346 (91.2%) responses from 39 medical schools that met the inclusion criteria were analysed. 16.5% of responses were newly appointed FY1 doctors. In their undergraduate training, the most commonly taught topics were urinary tract infection, acute kidney injury and haematuria; the least taught topics were male urinary incontinence, male infertility and erectile dysfunction. 90.6% and 86.3% had reported performing catheterisation as undergraduates on male and female patients respectively, and 16.9% had considered a career in urology. Conclusion LEARN provides the largest evaluation of any undergraduate specialty teaching. It has identified areas to improve teaching, to equip the future workforce with the competencies to manage urological pathology, irrespective of future career choice.

40 Across the Pond: Why Are Junior Doctors Seeking Surgical Training Abroad?

Abstract Introduction The loss of junior doctors from the NHS has been an ongoing issue. A subset are now seeking surgical training in other systems, such as the US. This is a costly and difficult process and many enter into undesignated positions with no guarantee of a job. With so much career uncertainty, why are trainees willing to take the risk? Method We performed a survey of trainees who graduated from British medical schools; all are currently enrolled in a US surgical training programme. They were asked about their experiences and perceptions of Results Nine trainees completed the survey. The most common time for trainees to move was during or after foundation training and the majority initially matched into preliminary positions. The most common reason cited to move was to receive better quality training. Many perceived the US training to be better and felt that they had a reasonable work-life balance. Conclusions The potential loss of the future NHS surgical workforce is worrying. Our survey highlights that surgical trainees place a high value on the quality of their training and were willing to enter an intense and uncertain process to achieve it. This needs to be addressed to retain potential trainees.

P73 LEARN: uroLogical tEAching in bRitish medical schools Nationally - a national retrospective multi-centre audit of urology teaching across British medical schools

IntroductionUrological conditions account for approximately 25% of acute surgical referrals and 10-15% of general practitioner appointments. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology that must be covered during undergraduate medical training. However, its uptake nationally remains unknown. This project aims to assess undergraduate urology teaching across UK medical schools.MethodsA targeted advertising drive using social media, medical school societies, websites and newsletters was performed over 4 weeks. Collaborators are responsible for recruiting survey respondents (year 2 medical students to foundation year 1 (FY1) doctors). Survey respondents will complete a REDCap survey retrospectively assessing their urology teaching to date. The primary objective is to compare current urology teaching in medical schools across the United Kingdom with the BAUS undergraduate syllabus.ResultsCurrently, 522 collaborators have registered from 36 medical schools nationally. Of these collaborators, 6.32% (33/522) are FY1s and 93.68% (489/522) are medical students. Each collaborator will be responsible for recruiting at least 15 survey respondents to be eligible for PubMed-indexed collaborator authorship.ConclusionLEARN has recruited successfully to date, with all collaborators from the medical student and FY1 cohort. With the role of collaborators to further recruit survey respondents, LEARN will provide the most representative and thorough evaluation of UK undergraduate urological teaching to date. It will provide evidence to support changes in the medical school curriculum, and allow re-evaluation of the current national undergraduate BAUS syllabus.

EurOP2E \u2013 the European Open Platform for Prescribing Education, a consensus study among clinical pharmacology and therapeutics teachers

PurposeSharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers.MethodsCPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting.ResultsData from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources.ConclusionKey challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system.

Study launch: uroLogical tEAching in bRitish medical schools Nationally (LEARN).

Study launch: uroLogical tEAching in bRitish medical schools Nationally (LEARN).

Medical students: privilege faced with poverty.

Growing up rich in poverty-stricken Malawi, I wanted for nothing. A white female, I was unhindered by lack of money, lack of education, language barriers, violence, poor health, gender, ethnicity, or religion, and I was somewhat aware of this privilege. I attended excellent schools, was loved by my family, and, as the crowning jewel of my secondary education, attained a place at a British medical school where I was confronted with and shocked by poverty in the UK. I sought to understand inequality here, where it seemed there was the means for universal prosperity. This took me to prisons, brothels, centres for impoverished families, and onto kerbstones with the homeless. In prison, I met torturers and murderers, but never someone whose story didn’t make sense. I wonder if I had grown up sexually abused in a care home, with a father who ‘taught me to box’ before I could walk, whether I too would join a gang, or …

Medical Students' Knowledge and Attitudes Toward Shared Decision Making: Results From a Multinational, Cross-Sectional Survey.

Introduction. We aimed to conduct a multinational cross-sectional online survey of medical students’ attitudes toward, knowledge of, and experience with shared decision making (SDM). Methods. We conducted the survey from September 2016 until May 2017 using the following: 1) a convenience sample of students from four medical schools each in Canada, the United States, and the Netherlands (n = 12), and 2) all medical schools in the United Kingdom through the British Medical School Council (n = 32). We also distributed the survey through social media. Results. A total of 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range = 18.8% to 100%; 95% confidence interval [CI] = 82.8% to 84.5%). US students had the highest knowledge scores (86.2%, 95% CI = 84.8% to 87.6%). The mean risk communication score was 57.4% (range = 0% to 100%; 95% CI = 57.4% to 60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients, and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, P < 0.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% v. 48.8%). A total of 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion. SDM knowledge is high among medical students in all four countries. Risk communication is less well understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.

Louie Mary Mangar

Louie Mary Mangar was born in Norwich, the only child and daughter of a headmistress and shoe business owner. she had a happy—albeit lonely—childhood, excelled academically at school, and in...

Influence of Student Selected Components on Medical Career Choice.

This article was migrated. The article was marked as recommended. Background and aims: Student selected components (SSC) offer a privileged opportunity for students to gain a deeper insight into areas of their personal interest, including potential careers. How different SSC programmes influence future career choice remains uncertain. The aims of this study were to investigate (1) how SSC programmes in British medical schools offer career exploration and (2) whether the experience of SSCs during medical school influences medical career choice. Methods: Two online surveys were sent to SSC leads in medical schools and to Foundation Year 2 doctors in the UK. This information was complemented with data available on medical school websites. Results and conclusions: A wide diversity of SSCs programmes is provided by medical schools across the UK, with variable compliance with GMC recommendations regarding career exploration. SSCs seem to play a paramount role in shaping career preferences during medical school and to exert a powerful influence on future career decisions. Therefore, it is imperative to design SSC programmes that allow students to explore several career pathways, including both medical and alternative careers, so that they can make informed decisions and hence avoid the detrimental consequences of inadequate career choices.

Irish Women in Medicine, c1880s–1920s: Origins, Education and Careers by Laura Kelly

Health & History Ɣ 19/1 Ɣ 2017 129 to Sydney he married and settled at Rose Bay, had two daughters, established a practice in nervous and mental diseases that included teaching hospital work, while continuing to research the ¿ne structure and function of mammalian brains and nervous systems. During the First World War, he provided care to neurological casualties from Gallipoli and was in charge of the neurological wards of the Australian Army Medical Corps hospital in Cairo. In the postwar period he contributed to understandings of psychoses and neuroses, taught medical graduates and postgraduates, and helped found the discipline of neurology. He died in 1937. Macmillan has done a masterful job of assembling the detail of Campbell’s life and achievements and contextualising them. But as he says himself, getting to the heart of the man ‘Snowy’ Campbell is dif¿cult because there is so little to draw on in the way of personal or work-related correspondence that survives. We are left to wonder about aspects of his character, habits, and interpersonal relationships. Even what inÀuenced him to go to Edinburgh, to spend a year on the Continent, and to return to Australia can only be the subject of speculation. These gaps present opportunities for further research, which Campbell himself would surely have appreciated. ANN WESTMORE UNIVERSITY OF MELBOURNE Laura Kelly, Irish Women in Medicine, c1880s–1920s: Origins, Education and Careers (Manchester: Manchester University Press, 2015). ISBN 9780719097409 (PB). Illustrations. xvi + 255pp. Laura Kelly’s detailed monograph is based on her doctoral thesis completed at NUI (National University of Ireland) Galway in 2010. Scrupulously researched, this new study unearths the ¿rst comprehensive history of Irish medical women in the late nineteenth and early twentieth centuries. Her focus is the 759 female students who took Irish medical degrees or licenses from 1885 to 1922. Author Enid Moberly Bell wrote Storming the Citadel: The Rise of the Woman Doctor (1953) to show the onerous challenges women students faced when attempting to enter medicine in the United Kingdom, as did feminist historian Catriona Blake almost 130 BOOK REVIEWS forty years later in The Charge of the Parasols: Women’s Entry to the Medical Profession (1990). Medical historian Thomas Bonner added his lively voice to the conversation in To the Ends of the Earth: Women’s Search for Education in Medicine (1992), comparatively documenting to 1914 the staggering migration of professional women in pre–Civil War America, Victorian England, and Tsarist Russia to the ¿rst-class medical schools in Parisian or Swiss universities, and the obstructions they needed to overcome to successfully qualify. Kelly develops the themes of these three earlier works, and claims that historians have not adequately engaged with the subject of women medical students, graduates, and doctors in Ireland in this period. She argues that unlike British medical schools, Irish medical schools and hospitals were much less hostile to early women students both at the time of admission, during their studies, and when they were quali¿ed doctors. By employing a new combination of contemporary and statistical sources, Kelly gives a broad insight into aspects that made the educational lives and professional careers of female medical graduates in Ireland different, and this is what makes it an important study. Kelly’s inclusion of tables and ¿gures help the reader digest multiple sets of data, which are valuable to researchers studying the history of women in medicine. Her forty page biographical index also provides golden opportunities for future research studies, comparative or otherwise. What enlivens the narrative and gives a deeper insight into the themes of previous chapters, are her engrossing case studies of ¿ve Irish women medical graduates revealed in Chapter Seven: Drs Emily Winifred Dickson, Emma Crooks, Lily Baker, Mary McGivern (later Connolly), and Jane D. Fulton (later O’Connor). As Kelly rightly points out, the latter two give the reader a window into the personal lives and careers of women doctors who might be described as ‘ordinary’. She sees this as a welcome change to the traditional case studies of ‘great men’ and ‘great women’, which usually dominate the history of medicine in Ireland. Kelly includes well-chosen and sometimes humorous reminiscences, particularly from Dr Fulton who in...

Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators.

IntroductionAgainst a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine.MethodsA quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30). Areas addressed included the association of anatomy with medical education and clinical practice, mode of instruction, and curriculum duration.ResultsGraduate-entry students were less likely to associate anatomy with the development of professionalism, teamwork skills, or improved awareness of ethics in medicine. Clinicians highlighted the challenge of tailoring anatomy education to increase student readiness to function effectively in a clinical role. Anatomy educators indicated dissatisfaction with the time available for anatomy within medical curricula, and were equivocal about whether curriculum content should be responsive to societal feedback.ConclusionsThe group differences identified in the current study highlight areas and requirements which medical education curriculum developers should be sensitive to when designing anatomy courses.

The (re)-introduction of semiotics into medical education: on the works of Thure von Uexküll

Thure von Uexküll's reputation as a pioneer in biosemiotics and also in psychosomatic medicine is well documented. It is easy to see these disciplines reflected in his notable publications, both...

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.