Clinical Professionalism Research Articles

The positive effect of student-oriented clinical clerkship rounds employing role-play and peer review on the clinical performance and professionalism of clerkship students

Background: Role-play (RP) and peer review (PR) are occasionally used in training and evaluating communication skills in clinical clerkship (CC). Thus, we evaluated the effect of combining RP and PR during student-oriented CC rounds.Methods: Clerkship students conducted medical interviews with and performed physical examinations on their patients, which were reviewed by five peer students who observed their performance while role-playing as senior physicians or patients’ families. The peer reviewers then provided feedback to the students. The performance of the students was evaluated based on a mini-clinical evaluation exercise (Mini-CEX) and a professionalism mini-evaluation exercise (P-MEX) before and after the rounds by two attending physicians. After the CC, the students responded to questionnaires about the rounds.Results: Seventy-five students completed the rounds, and the duration of each round was 41.7 ± 7.1 min. Their communication skills and professionalism abilities on Mini-CEX and P-MEX showed significant improvement after the rounds. Improvements in medical interviewing and physical examinations were also noted. Additionally, the students recognized the importance of multiple viewpoints in patient care through experiences of the rounds.Conclusions: Combining RP and PR with CC rounds improves the students’ clinical performance and professionalism and promotes their awareness of the importance of multiple viewpoints in patient care.

Deliberations on the contemporary assessment system

Deliberations on the contemporary assessment system

How does the 'care of the self' impact on fitness to practice in dental education?

This article was migrated. The article was marked as recommended. Foucault defines care of the self as activities which "permit individuals to effect by their own means or with the help of others a certain number of operations on their own bodies and souls, thoughts, conduct, and way of being, so as to transform themselves in order to attain a certain state of happiness, purity, wisdom perfection, or immortality" ( Foucault, 1988). This paper will explore how the care of the self impacts on fitness to practice in dental education. Fitness to practice refers to a student's competence, including clinical skills and professionalism as well as the ability to reflect on their own health and capabilities. This paper will examine how the dominant discourse of reflective practice influences a student's care of the self using techniques of writing and verbalisation, and how the development of competent graduates is tied to Foucault's work on disciplinary power, panopticism and governmentality. The role of pastoral power and confession, and the relationship of educators and students will also be explored.

Clarifying the role of clinical supervisors according to physiotherapists at a higher education institution.

BackgroundThe roles of doctors and nurses in clinical supervision and clinical education are well defined. The role of the physiotherapist in clinical education has not been clearly defined.ObjectivesThe aim of this study was to define and clarify the views and experiences of physiotherapy clinical supervisors regarding clinical education and their role in contributing to student learning.MethodsThis qualitative exploratory study targeted 17 physiotherapy clinical supervisors, employed in a physiotherapy department, at a local university in the Western Cape. Twelve of the 17 participants agreed to participate in the study. Data were collected by means of in-depth audio-taped interviews, at a time convenient for the participants. Each transcript was read individually by the first author and notes made in the margins to highlight interesting concepts that emerged. The different types of concepts were listed and categorised, while common categories were grouped into themes.ResultsBased on the results, the clinicians’ role is viewed as a valuable asset in clinical education, embodying the role of an educator, mentor, role model and communicator. Clinical supervisors discussed their roles in terms of understanding the importance of clinical supervision, providing guidance within a clinical setting, role modelling and professionalism. Although clinical supervisors play a significant role, they experienced a few challenges including role clarification and students’ lack of knowledge.ConclusionThis study highlights that clinical supervisors and clinicians fulfil significant roles in assisting students to integrate theoretical and clinical knowledge.Clinical implicationsUnderstanding the expectations of clinical supervisors in supporting clinical education is important for higher education institutions and the clinical sector.

Forward Feeding in Graduate Medical Education: Results of a National Survey.

"Forward feeding" is defined as the sharing of information regarding learner behaviors and performance outside of formal institutional committee structures. The purpose of this study was to establish baseline opinions and policies of forward feeding in family medicine residency programs. Data for this study were obtained as part of the 2015 CERA Program Directors Fall Survey. Program directors indicated whether they felt that faculty should and do engage in forward feeding. Respondents were asked to rate the importance of various types of information about learners (academic performance, clinical performance, professionalism, physical health, and mental health), reasons for promoting, and concerns regarding forward feeding on a 5-point Likert scale. The overall response rate was 49% (227/461). Most agreed that faculty should (87%) and do (83%) engage in forward feeding. Concerns regarding professionalism and clinical performance were reported as most important to share. The most important reason identified for forward feeding was the early identification of struggling residents, followed by the ability to direct teaching to the resident's specific needs, and improving the quality of feedback. Fear of creating bias was the most commonly cited concern for engaging in forward feeding, followed by fear of violating confidentiality and difficulty maintaining confidentiality. Fear of litigation was the least common concern. Despite concerns, the majority of program directors feel that faculty should and do engage in forward feeding. Our study confirms the importance of clinical performance and professionalism as two important themes of information shared by attendings about residents.

Assessment of pathology trainees’ satisfaction: results of a survey from Sudan

Background: Assessment of students, trainees and graduate’s satisfaction in medical education and clinical training is an important guide for the improvement of educational and training programs. The objective of this study is to assess the satisfaction of histopathology graduates with the training in the MD pathology program, Medical and Health Studies Board (MHSB) University of Khartoum (UofK). Methods: This is a cross-sectional study conducted at the University of Khartoum Graduate College/MHSB/MD pathology program, within the period from September to December 2017. Fifteen graduates were surveyed using a closed-ended unipolar 5 grade Likert’s scale, through a self -administered questionnaire covering 15 areas and 33 items of pathology training. Areas covered were: program entry examination, part one two years course, induction, the content of learning, learning methods, duration of the rotation, organization and management of learning activities, laboratory management, research experience, educational and clinical supervision, hand over, communication, professionalism, assessment, and overall satisfaction. Results: Results of assessment of satisfaction with the 15 areas can be grouped into three groups: the first group composes of areas with good satisfaction (five areas): Handover 93.7%, entry examination 86.75%, research experience 80%, learning methods 73.3%, and assessment 70.8%. The second group with moderate satisfaction (five areas) each scored 66.7%: Organization, laboratory management, supervision, communication, and overall satisfaction. The third group reflecting areas of dissatisfaction and scores was less than 50% (areas were induction, part one course, duration of training, teaching about professionalism and learning content). Conclusions: Overall, the graduates have a good level of satisfaction with postgraduate pathology training. Future reform of the histopathology curriculum will help to increase graduate’s satisfaction and will consequently result in improving pathology training and services.

Grit, Clinical Practice Stress and Professionalism in Nursing Students

Grit, Clinical Practice Stress and Professionalism in Nursing Students

A dramatic way to teach clinical reasoning and professionalism.

A dramatic way to teach clinical reasoning and professionalism.

Clinically Excellent Use of the Electronic Health Record: Review.

BackgroundThe transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving health care. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed.ObjectiveUsing the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence, this review aims to identify best practices around the clinically excellent use of the EHR.MethodsThe authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000, and August 2, 2016. One author independently reviewed each article and extracted relevant data.ResultsThe search identified 606 titles, with the majority (393/606, 64.9%) in the domain of communication and interpersonal skills. Twenty-eight of the 606 (4.6%) titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The remaining 578 full-text articles reviewed were related to clinical excellence generally (3/578, 0.5%) or the specific domains of communication and interpersonal skills (380/578, 65.7%), diagnostic acumen (31/578, 5.4%), skillful negotiation of the health care system (4/578, 0.7%), scholarly approach to clinical practice (41/578, 7.1%), professionalism and humanism (2/578, 0.4%), knowledge (97/578, 16.8%), and passion for clinical medicine (20/578, 3.5%).ConclusionsResults suggest that as familiarity and expertise are developed, clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to involve sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time, and hopefully continued clinician, and patient input will lead to a system that satisfies all.

Clinical communication skills and professionalism education are required from the beginning of medical training - a point of view of family physicians

BackgroundThe Brazilian undergraduate medical course is six years long. As in other countries, a medical residency is not obligatory to practice as a doctor. In this context, this paper aims to clarify what and when competencies in communication and professionalism should be addressed, shedding light on the role of university, residency and post-residency programmes.MethodsBrazilian family physicians with diverse levels of medical training answered a questionnaire designed to seek a consensus on the competencies that should be taught (key competencies) and when students should achieve them during their medical training. The data were analysed using descriptive statistics and correlation tests.ResultsA total of seventy-four physicians participated; nearly all participants suggested that the students should achieve communication and professionalism competencies during undergraduate study (twenty out of thirty competencies – 66.7%) or during residency (seven out of thirty competencies – 23.33%). When competencies were analysed in domains, the results were that clinical communication skills and professionalism competencies should be achieved during undergraduate medical education, and interpersonal communication and leadership skills should be reached during postgraduate study.ConclusionThe authors propose that attainment of clinical communication skills and professionalism competencies should be required for undergraduate students. The foundation for Leadership and Interpersonal Abilities should be particularly formed at an undergraduate level and, furthermore, mastered by immersion in the future workplace and medical responsibilities in residency.

Enhancing professionalism in physiotherapy interns using a structured teaching and assessment module

INTRODUCTION: Professionalism describes the skills, competency, attributes, and behavior of an individual belonging to a profession. The physiotherapy graduate on completion of internship has direct access with the community as a professional. Hence, there is a need to explicitly teach and assess professionalism. The purpose of this study was to prepare a module to enhance professionalism and use tools to assess the professional attributes uniformly.MATERIALS AND METHODS: A module was formulated with the help of experts, literature review, and guidelines of various physiotherapy regulatory bodies nationally and internationally. Focused group discussions were used as a method to identify competencies. After designing the module, a prospective intervention trial was conducted wherein 40 students who joined the internship program of a tertiary care hospital of India, were enrolled for the study. A participatory approach was used which included an interactive workshop on “ethics in clinical practice, communication skills, and professionalism.” A written pre-post evaluation and workplace-based assessment were carried out in four core physiotherapy areas. Competencies and attributes were measured using tools such professional mini-evaluation exercise (P-MEX), prevalidated checklist for clinical reasoning, patient feedback form, and a retro-preevaluation of self-assessment form of the American Physical Therapy Association.RESULTS: A total of 34 students completed the module. Data were analyzed using SPSS 16 software. Nonparametric Wilcoxon Signed Rank test was used to analyze the descriptive data. The statistical significance was kept at P < 0.05 at a confidence interval of 95%. There was a statistically significant increase in the knowledge component pre-post analysis (P < 0.00). Change in professional attributes as measured by P-MEX showed a significant change in Doctor-patient relationship (P < 0.01) and interprofessional skills (P < 0.001) followed by reflective skills (P < 0.007) and time management skills (P < 0.003). There was also a significant difference in total patient feedback scores from baseline (P < 0.01).CONCLUSION: The module helped students gain the knowledge and skills required to communicate and handle difficult situations relevant to physiotherapy practice.

Effect of department climate on medical professional attitudes and behaviours of Chinese clinical physicians: a cross-sectional investigation

BackgroundAn increasing number of empirical studies on medical professionalism in clinical practice settings have been conducted since 2002. However, few of them were carried out in China, and few focused on the influence of department climate on clinical physicians' professionalism. Our study investigated Chinese clinical physicians' professional attitudes and behaviours, and evaluated the effect of department climate on their attitudes and behaviours. MethodsSelf-administered questionnaires including 20 items on professional attitude, ten items on behaviour, and 29 items on department climate were distributed to clinical physicians in four public hospitals in non-capital cities in Sichuan and Hubei Provinces, China, from Nov 29 to Dec 7, 2016. Verbal informed consent was obtained from the participants. Findings327 valid questionnaires were collected. More than 305 (94%) respondents agreed with 13 of 20 specific statements on medical professionalism. 125 (38%) respondents disagreed with reporting incompetent colleagues, 113 (35%) disagreed with recertification, and 98 (30%) disagreed with reporting medical errors. More than 294 (90%) respondents reported that they sometimes, usually, or always manifested the four positive behaviours on the questionnaire, and more than 261 (80%) reported that they never displayed the six negative behaviours. Factor analysis indicated that the department climate scale (26 items) consists of six dimensions. Regression analyses indicated that the predictors of professional attitudes were two dimensions of climate scale (serving patients [β 0·325, 95% CI 0·153–0·307] and work support [0·170, 0·036–0·161]; adjusted r2 0·174). Physicians' behaviour was significantly influenced by one dimension of climate scale (serving patients; β 0·280, 95% CI 0·112–0·254), professional attitude (0·182, 0·067–0·269), and educational background (Master's degree [0·244, 0·076–0·305] and Bachelor's degree and above [0·193, 0·032–0·238; comparison group is below Bachelor's degree]; adjusted r2 0·169). InterpretationPhysicians showed relatively positive professional attitudes and behaviours. Department climate (especially the dimension of serving patients) affected physicians' attitudes and behaviours, suggesting that improvement of department climate in the hospital is an important strategy to enhance professionalism. FundingNational Natural Science Foundation of China (71203069, 71573094), the Fundamental Research Funds for the Central Universities, HUST (2013WZ024, 2015AC027).

Defining curricular priorities for student-as-teacher programs: A National Delphi Study

Background: “Student-as-Teacher” (SaT) programs have been growing in number to prepare medical students for their teaching roles in residency and beyond, but it remains unknown what content areas should be covered in SaT curricula.Aim: To determine five to ten “essential” content areas for inclusion in SaT curricula using expert opinion.Methods: Using a three-round Delphi process, moderators iteratively surveyed a panel of 28 medical educators (25 academy directors and three individuals identified as having expertise in undergraduate medical education) representing 25 medical schools in the United States. This “SaT Delphi Working Group” was tasked with rating topics for inclusion in SaT curricula on a 3-point scale (i.e. 1. “essential,” 2. “important, but not essential” 3. “not important”). Topics achieving ≥70% consensus as “essential,” “important” or “not important” were accepted by the moderators and removed from subsequent rounds.Results: Hundred per cent response rate (n = 28) was achieved for all survey rounds. Five content areas reached consensus as “essential” for inclusion in a SaT curriculum: feedback, bedside teaching and clinical precepting, small-group teaching, case-based teaching and professionalism as a medical educator.Conclusion: This consensus from a group of leaders in medical education is a first step toward the implementation of more developmentally-appropriate SaT competencies.

Clinical Skills and Professionalism: Assessing Orthopaedic Residents With Unannounced Standardized Patients

We developed a series of orthopedic unannounced standardized patient (USP) encounters for the purpose of objective assessment of residents during clinic encounters. Consecutive case-series. NYU-Langone Multi-center Academic University Hospital System. NYU-Langone/Hospital for Joint Diseases Orthopedic Surgery residents; 48 consecutive residents assessed. Four orthopedic cases were developed. USPs presented themselves as patients in outpatient clinics. Residents were evaluated on communication skills (information gathering, relationship development, and education and counseling). USPs globally rated whether they would recommend the resident. Forty-eight USP encounters were completed over a 2-year period. Communication skills items were rated at 51% (±30) "well done." Education and counseling skills were rated as the lowest communication domain at 33% (±33). Residents were globally recommended based on communication skills in 63% of the encounters recommended in 70% of encounters based on both professionalism and medical competence. The USP program has been useful in assessing residents' clinical skills, interpersonal and communications skills, and professionalism. Use of USP in orthopedic surgery training programs can be an objective means for trainee assessment.

Assessing the Culture of Residency Using the C - Change Resident Survey: Validity Evidence in 34 U.S. Residency Programs.

A practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents. To develop and present evidence of validity of an instrument to assess the culture of residency programs and the clinical learning environment. During 2014-2015, we surveyed residents using the C - Change Resident Survey to assess residents' perceptions of the culture in their programs. Residents in all years of training in 34 programs in internal medicine, pediatrics, and general surgery in 14 geographically diverse public and private academic health systems. The C - Change Resident Survey assessed residents' perceptions of 13 dimensions of the culture: Vitality, Self-Efficacy, Institutional Support, Relationships/Inclusion, Values Alignment, Ethical/Moral Distress, Respect, Mentoring, Work-Life Integration, Gender Equity, Racial/Ethnic Minority Equity, and self-assessed Competencies. We measured the internal reliability of each of the 13 dimensions and evaluated response process, content validity, and construct-related evidence validity by assessing relationships predicted by our conceptual model and prior research. We also assessed whether the measurements were sensitive to differences in specialty and across institutions. A total of 1708 residents completed the survey [internal medicine: n = 956, pediatrics: n = 411, general surgery: n = 311 (51% women; 16% underrepresented in medicine minority)], with a response rate of 70% (range across programs, 51-87%). Internal consistency of each dimension was high (Cronbach α: 0.73-0.90). The instrument was able to detect significant differences in the learning environment across programs and sites. Evidence of validity was supported by a good response process and the demonstration of several relationships predicted by our conceptual model. The C - Change Resident Survey assesses the clinical learning environment for residents, and we encourage further study of validity in different contexts. Results could be used to facilitate and monitor improvements in the clinical learning environment and resident well-being.

Management Tools for Quality Performance Improvement in Italian Hospitals

ABSTRACTLeadership plays a decisive role in improving the quality performance in healthcare organizations. Research examines how Italian hospitals generate conditions to support leadership, at both top management and department/unit level, in improving quality. It focuses on the role of the management in processes for the delegation of responsibilities, and tools implemented to facilitate clinical leadership. Data show that: mandate is linked to full accountability; top management supports leadership for reinforcing outputs; and evaluation processes are systematically implemented. Furthermore, data show that leaders require performance systems to enhance clinical professionalism and to commit to improving performance.

Analysis of the related factors on scores of the clinical dietitians' post-training exam in China

Objective Based on the analysis of relevant factors on scores of the first clinical dietitian post-training examination (CDPTE) in China, to explore the clinical dietitians' post competency evaluation basis. Method 108 students who completed the clinical nutritionist training (60 physicians, nurse or technician 48) were imposed comprehensive evaluation designed according to the concept of post compe-tency. Through analysis and comparison, the correlation factors of the candidates' passing rate and their mastering rate of the module were studied. Results The results of all the candidates' comprehensive theoretical examination increased with the degree and the source of the candidates. Among them, the college students 'pass rate was 76.47%, undergraduates' pass rate was 86.21%, Graduates' pass rate was 96.97%; the pass rate in western region was 85%, the central part was 85.71%, the eastern part was 89.55%. All the candidates' knowledge module mastery rate in the comprehensive examination of the theory from high to low in order was: for hospital diet (73.7%), enteral nutrition and parenteral nutrition (72.7%), public nutrition (70.7%), nutrition screening and assessment (66.7%), common nutrition related diseases (65.4%), clinical nutrition related health students regulations, medical psychology and ethics basic knowledge (40.0%). The examination pass rate was related to the educational level of the examinee and the source area, while the knowledge module mastery rate was closely related to the work of clinical nutrition. Conclusion We concluded that the CDPTE could objectively reflect the candidate's clinical competence and professionalism and it was designed on the basic principle of post competency. CDPTE has a positive significance for scientific assessment of clinical dietician, guide for training, and evaluation of training effects as well. The scores of CDPTE can objectively reflect the examinees 'clinical competence and professionalism and CDPTE can achieve the goal of evaluating the candidates' competency, and it is of practical significance for scientific evaluation of clinical practice, guiding learning and evaluating the training effect. Key words: Clinical dietician; Post-training exam; Educational assessment; Competency

Importance of incorporating teaching of feedback skills into medical curricula.

Dear editor In the study by Burgess and Mellis,1 the importance of feedback in the learning process of the medical students has been discussed. The teaching of the medical students carries immense significance throughout their clinical career. At university, students learn skills that are embedded into their attitudes and behaviors for many years to come. Furthermore, these skills, in effect, become second nature to them, making them harder to adapt later. Therefore, it is important to equip students with the correct feedback skills and techniques early in their education. We agree with the conclusions drawn by Burgess and Mellis1 that feedback is crucial for learning and that the teaching of feedback skills should be a core component of medical education programs. However, despite their crucial significance, we believe that feedback skills are not adequately taught and practiced in medical schools. The study of medicine is a balance of theoretical, scientific knowledge obtained through lectures or books and clinical skills gained through empirical observation and participation. Clinical skills are best learned through guidance from experienced supervisors and feedback that the students can build upon. Unfortunately, this is currently not being adequately delivered in clinical settings. For example, according to the data gathered from the National Student Survey on the undergraduate medicine programs in Bristol, Edinburgh, and Cardiff, only 30%, 30%, and 40% of students, respectively, found that the feedback they received on their work helped clarify things they did not understand.2–4 The deficiency of helpful feedback could be due to the lack of appropriate education received by the teachers themselves (eg, clinical doctors) during their time in the medical school regarding how to provide feedback. As universities educate students to become competent doctors of the future, it falls within the duties of faculties to ensure that the future doctors will be able to provide adequate feedback later in their careers, especially when training the next generation of the medical students. Therefore, feedback should be implemented as an essential part of medical education at the university level. Additionally, Burgess and Mellis1 make an interesting point that receiving feedback should not be considered as a passive act. Algiraigri5 states that the lack of student empowerment inhibits them from using received feedback appropriately and further suggests that this may be due to the hierarchical nature of educational institutions. This implies that students are often placed into a position of passive participation in the feedback process, rather than being active members who take ownership of the received feedback. Crucially, in order for feedback to take strong effect, a behavioral change must be invoked, which is only attainable through student involvement. To achieve this, besides being taught how to give feedback, students should be guided on how to understand and utilize the feedback that they are given in order to benefit their own learning experiences. As the importance of feedback is increasingly recognized, some medical faculties are now teaching certain teaching skills to the students, including feedback giving, in their undergraduate programs.6 However, Kruidering-Hall et al7 found that the specificity of student feedback fell over time, before and after the students were taught how to deliver feedback, implying that the ability to provide high-quality, specific feedback can be a complicated skill to learn and requires consistent teaching and evaluation. This notion is further strengthened by other studies where incorporating feedback in an attempt to aid students in learning clinical skills was unsatisfactory.8,9 The relatively unsuccessful use of feedback in these studies could be the direct result of students not being taught to give or receive effective feedback, thereby making the exercise of incorporating feedback useless. This highlights a problem that needs to be addressed actively by universities in improving their medical curricula, especially as there is growing evidence to indicate that the medical students feel that the use of feedback can be helpful and beneficial in their own learning of certain clinical skills, for example, anatomy10 or professionalism.11 In conclusion, it is important for the medical students to be taught feedback skills as well as how to process feedback in an objective manner and transpose this to benefit their own knowledge and clinical skills. To obtain these goals, we believe that there must be a structural change in the methods in which medical education is provided to incorporate a strong focus on teaching students how to provide and receive feedback. Furthermore, as the literature is lacking where teaching methods of feedback skills in medical education is concerned, we believe that there is a need for further studies to assess the concerns voiced earlier.

Nursing competency standards in primary health care: an integrative review.

This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Integrative review. A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content of competency standards internationally is an important step to understanding this growing workforce.

Implications of aligning full registration of doctors with medical school graduation: a qualitative study of stakeholder perspectives

ObjectivesThe Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK...