General Medical Council Research Articles

Sustainable quality improvement: An essential ingredient for sustainability in modern medical curricula?

Health care delivery contributes a significant carbon footprint in the United Kingdom, and paradoxically climate change is linked to poorer human health outcomes. New General Medical Council (GMC) requirements mandate medical graduates must be able to apply sustainable care to their practice. Implementation of sustainable health care (SHC) teaching is a new challenge for medical schools, and there are several identified barriers including an overcrowded curriculum, lack of expertise within faculties, lack of institutional support and inadequate assessment techniques. We established a new SHC curriculum spiralling throughout the overall medical curriculum, and as part of this introduced a sustainable quality improvement (susQI) project to our final year cohort. SusQI considers the environmental, social and financial impacts as well as patient and population outcomes. Our students undertook this in their final year GP assistantships. We sought multi-sourced data through focus groups, formal end of placement feedback, informal feedback and external feedback. We applied thematic analysis to focus group transcriptions and triangulated with the other data sources. We identified some common themes: First, susQI was enjoyed and valuable; second, it allowed meaningful participation; third, it created a co-learning environment; and fourth, timing and curriculum placement are important when integrating susQI. SusQI can implement SHC into the overcrowded medical curriculum in a low cost, low resource manner without the need for experienced faculty. SusQI is empowering for students and grants them an active team role. Expansion into secondary and tertiary care is feasible, and we contend that susQI can be placed in other health care curricula.

Cost of Training Crisis: Anaesthetics.

The anaesthetic training programme in the United Kingdom (UK) spans over seven years and is overseen by the Royal College of Anaesthetists (RCOA). Junior doctors in England are currently striking amid ongoing pay negotiations with the government, and almost all junior doctors are worried about the cost of living. This article provides an overview of the average financial cost of training for doctors in the anaesthetic training programme. The cost incurred by anaesthetic trainees illustrates the level of financial burden faced by trainees across multiple specialities. The cost includes: student loan repayment (with interest rates), compulsory membership fees (including the Royal College of Anaesthetists and General Medical Council), postgraduate examinations (Fellowship of the Royal College of Anaesthetist exams are compulsory to complete training) and medical indemnity. The average trainee spends between 5.6% and 7.4% of their annual salary on non-reimbursable costs. This article delineates for aforementioned expenses and compares them with the training programs in Australia and New Zealand, given their status as frequent emigration destinations for UK doctors.

P037 Rheum for more? A systematic literature review on undergraduate exposure to rheumatology

Abstract Background/Aims Since the introduction of Modernising Medical Careers by the General Medical Council in the United Kingdom (UK) in 2007, newly-qualified doctors are expected to choose their specialty much sooner than previously. A recent report published by the British Society of Rheumatology (BSR) in 2021 demonstrated a lack of exposure to the specialty for medical students. We conducted a systematic literature review on the quantity and quality of rheumatology teaching amongst undergraduate medical students. Methods Articles published until June 2023 were included. Eligible articles were: case reports and series, observational studies, qualitative studies and randomised control trials. Medline, Embase, PyscINFO, Cochrane library and WHO international clinical trial registry were searched, restricted to English language articles only. Articles including postgraduate trainees and those pertaining to a single intervention or single student cohort were excluded. Information was extracted on demographics, method of teaching, hours dedicated to rheumatology and students’ and educators’ feedback where mentioned. Results After deduplication, 1195 article were identified. After screening title and abstract, 1156 papers were excluded, with 39 proceeding to full text screening. Ultimately, seven articles (all cross-sectional surveys) were included. Publication year of included articles ranged from 1981 to 2018. The countries of included studies were UK (3), USA (2), Australian (1) and Pan-European (1). Year of rheumatology teaching at medical school was reported in four studies (3 UK and 1 USA). The three UK studies were all taught in the latter years (4-6), whereas in the USA study the students were taught at every single year. Where reported, data on the number of hours of exposure to rheumatology were variable, ranging from 15 to 96 hours per medical student. Reported method of teaching included lecture-based, rheumatology inpatient service and shadowing consultations. Student feedback was only provided in one (UK-based) study, from 49 students of whom two regarded rheumatology as “fascinating”, four felt that they had limited exposure and eight considered it as “a niche specialty of no interest”. No feedback from educators were collected in any of the included studies. Factors identified by the included studies for overall poor exposure to rheumatology included: lack of having full-time rheumatologists on the school’s faculty, lack of specialty training programme in their local teaching hospital and greater emphasis on general medical/ acute specialties (e.g. general practice and emergency medicine). Conclusion Overall, there are significant limitations in recording the amount and quality of rheumatology teaching amongst undergraduate medical students. Exposure to clinical rheumatology has markedly decreased over time, with variable student awareness of the speciality. Given the ageing UK population and increase in multimorbidity, there is a need to increase exposure and entry to the specialty, which may be partly facilitated by improved incorporation of rheumatology in the undergraduate curriculum. Disclosure K. Kouranloo: None. N. Myall: None. J. Christie: None.

Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS

Background: With the global scarcity of the healthcare workforce, innovations in healthcare professional (HCP) roles include the model introduced in the 1960s in the USA of medical associate professionals (MAPs). Since 2003 in the UK, MAPs had a scope of practice defined by local employers. In 2024, the UK Parliament passed a resolution to bring the MAPs under regulation by the General Medical Council. However, multidisciplinary team and public awareness of MAPs have come under scrutiny, due to uncertainties around roles, unmonitored expansion of scope of practice, patient safety concerns, and competition for jobs and training with doctors. There is a need for rigour in exploring the opinions of the whole spectrum of HCPs, especially locally employed doctors (LEDs), Specialty and Associate Specialities (SAS) and international medical graduates (IMGs) who not only make up a large cohort of doctors in the UK but work closely with MAPs and support their prescribing and ordering investigations functions. Aim: Designed by a multi-professional working group, an online survey of HCPs was conducted to explore the role of MAPs in patient care, and how workforce plans around the roles align with the roles, responsibilities, and training of doctors. Findings: A total of 583 responses were collected which included consultants (43%), postgraduate doctors in training, General Practitioners, LEDs, IMGs (75%), nurses, and allied health professionals. Role: 53% of respondents were uncertain of the specific role of MAPs within the team; 43% agreed primary roles of MAPs involved delivering specific, well-defined skill-based services, reducing workload (20%), and providing continuity (19%). 89% emphasised the importance of a clear distinction between the roles of doctors and MAPs. Patient Safety: 77% agreed that MAPs currently may pose a risk to patient safety. 89% recognised the risk associated with MAPs working beyond their scope. 69% agreed with the need for a competency framework for MAPs. Supervision: 75% expressed concerns about the increased clinical risk and burden faced by doctors in supervisory roles. Impact on Doctors: 69% reported reduced job prospects and 67% reduced training opportunities. Regulation: 74% agreed with regulation by an independent regulator, not the GMC. Free text: The analysis of free-text comments revealed a predominantly negative sentiment regarding the role of MAPs. Concerns about patient safety, lack of proper training, additional workload implications for doctors, the potential for misrepresentation, the erosion of training opportunities for doctors, the risk of scope creep, and confusion among patients. Conclusion:  Innovation in healthcare professional roles and functions is key to supporting the human resource shortage in health systems. The results of this survey from Multiprofessional respondents including IMGs, suggest that caution is required in how roles are positioned to the public, to avoid blurred lines of responsibility or interchange between professional roles, and to avoid confusion and consequent risk to the public. MAPs need a robust national framework of competencies, an independent regulator for licensing, and support doctors but not compete for resources, jobs, and training opportunities.

Medical Associate Professionals in the UK

Anyone who has any connection with the world of social media will be aware of the ‘storm in a teacup’ that has been brewing in the last few months with Medical Associate / Assistant Professionals (MAPs) in the UK as Parliament debated and swiftly passed legislation1 related to their regulation by the UK General Medical Council. In its supporting statement, the UK Minister for Health2 specified,
  
 ‘Physician associates work under the supervision of doctors taking medical histories, carrying out physical examinations, performing some medical procedures and analysing test results. Anaesthesia associates review patients before surgery, initiate and manage medications, administer fluids and blood therapy during surgery, and ensure there is a plan for patients following their operation. Both roles can work autonomously, but always under the supervision of a fully trained and experienced doctor.’
 The legislation was passed in the UK Parliament in Feb24 and will be in force from Dec’24.
 The British Association of Physicians of Indian Origin (BAPIO) is leading a survey 17and workshop designed to have a 360-degree review of the impact of MAPs on training and career progression for all doctors, including the missing voice of several thousands of doctors who are not in formal training, are locally employed on shorter-term contracts, are considered as speciality doctors by the GMC. A vast proportion of these doctors are international medical graduates, and a significant proportion belong to cohorts who are under-represented in leadership positions (including those that were previously considered from Black or minority ethnic groups). The workshops and focus groups will include representation from all under-represented groups of doctors across the spectrum, patient representatives, nursing, and allied healthcare professionals who form an integral part of the MDT, medical leaders, higher education institutions, NHS workforce Training and Education and NHS employers. The results of the independently facilitated focus groups and survey results will be published with recommendations for all stakeholders in May 2024, and aim to provide a framework for action, reflecting consultation and views of the whole healthcare profession. 

Challenges and expectations of international medical graduates moving to the UK: An online survey.

International medical graduates (IMGs) account for 41% of the UK doctor's workforce but often work in isolated roles, receive minimal constructive feedback regarding their work and offered limited opportunities for career progression. We conducted a survey researching the views of IMGs or doctors from ethnic minority backgrounds on the support given to them. A survey was carried out on physician demographics, grade and date of first NHS appointment, familiarity and support offered in NHS, induction and study leave, Professional and Linguistic Assessments Board exams and General Medical Council (GMC) referrals. It was drafted via surveymonkey.co.uk platform and circulated via relevant closed medical groups. A total of 173 IMGs and 16 British trained doctors (controls) took the survey. In the IMGs first job, there was no dedicated supervisor, mentor, induction, shadowing period and study leave for 56%, 86%, 52%, 59% and 52%, respectively. Suggestions given for improvements included teaching sessions, mentors, work orientation, supernumerary period and paid induction by 80%, 78%, 76%, 61% and 41% respectively. While 59% of participants knew of another IMG referred to the GMC, the primary reasons given were lack of knowledge of NHS, bias, communication difficulties and cultural differences. This paper reflects the views of doctors regarding the support given to IMGs during their first NHS appointment and subsequent jobs in the NHS. IMGs require a focused and detailed induction, mentorship, educational and clinical supervision throughout their transition to the NHS.

Undergraduate deficits in plastic surgery exposure and awareness of the specialty: a systematic review.

Plastic surgery is an important specialty that involves widespread medical knowledge, some of which is taught in undergraduate curricula. The General Medical Council provides a well-defined plastic surgery curriculum for postgraduate training. However, there is no consensus on the provision for undergraduates in this specialty, potentially giving rise to a deficit in undergraduate medical education and a suboptimal basis for plastic surgery postgraduate training. Our aim was to identify the gap in undergraduate plastic surgery teaching and to understand student perceptions of the specialty as well as any trialled interventions. A prospectively registered systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase™, PubMed® and Google Scholar™ databases were searched for literature relating to undergraduate exposure to plastic surgery and relevant teaching interventions. Ten studies were included in this review, categorised into three main themes: exposure during medical school, determining factors and perceptions for pursuing a plastic surgery career, and teaching interventions. Surveys assessing medical student perceptions indicate a significant deficit in exposure to plastic surgery in the undergraduate curriculum. Medical students' interest in the specialty is affected by multiple factors, including the amount of surgical exposure in medical school. Interventions to address the deficit mostly involve one-day courses. Although the literature is currently limited, studies are needed to effectively assess the outcomes of plastic surgery teaching methods in undergraduate training. Moreover, there is a need for consensus around the provision of undergraduate teaching in plastic surgery. This should be reflected in the latest undergraduate curricula in medical education.

Mind the implementation gap: a systems analysis of the NHS Long Term Workforce Plan to increase the number of doctors trained in the UK raises many questions

Abstract Background The National Health Service (NHS) in England is facing a workforce crisis. A new Long Term Workforce Plan (LTWP) seeks to address this, setting out ambitious proposals to expand and reform domestic medical education and training in England. However, there are concerns about their feasibility. Sources of data In September 2023, over 60 individuals representing medical education and training in the UK participated in an exercise run by UK Medical Schools Council by using systems theory to identify risks. Areas of agreement The UK does need more ‘home grown’ doctors, but the LTWP has important gaps, including lack of attention to postgraduate training, absence of reference to the need for more educators and capital investment and risk of inadequate clinical placement capacity, particularly in primary care settings. Areas of controversy There are unresolved differences in the understanding of a proposed medical apprenticeship model and no scheme has, as yet, been approved by the General Medical Council. Participants were unable to determine who the beneficiaries of this scheme will be (apart from the apprentices themselves). Growing points While the LTWP represents a welcome, although overdue, commitment to address the NHS workforce crisis, we identified significant gaps that must be resolved. Areas timely for developing research First, the development of the LTWP provides a case study that adds to literature on policymaking in the UK. Second, while we only examined the expansion of medical training, the method could be applied to other parts of the LTWP. Third, a prospective evaluation of its implementation is necessary.

Gender, flexibility and workforce in the NHS: A qualitative study.

Data from the General Medical Council show that the number of female doctors registered to practise in the UK continues to grow at a faster rate than the number of male doctors. Our research critically discusses the impact of this gender-based shift, considering how models of medical training are still ill-suited to supporting equity and inclusivity within the workforce, with particular impacts for women despite this gender shift. Drawing on data from our research project Mapping underdoctored areas: the impact of medical training pathways on NHS workforce distribution and health inequalities, this paper explores the experiences of doctors working in the NHS, considering how policies around workforce and beyond have impacted people's willingness and ability to continue in their chosen career path. There is clear evidence that women are underrepresented in some specialties such as surgery, and at different career stages including in senior leadership roles, and our research focuses on the structural factors that contribute to reinforcing these under-representations. Medical education and training are known to be formative points in doctors' lives, with long-lasting impacts for NHS service provision. By understanding in detail how these pathways inadvertently shape where doctors live and work, we will be able to consider how best to change existing systems to provide patients with timely and appropriate access to healthcare. We take a cross-disciplinary theoretical approach, bringing historical, spatiotemporal and sociological insights to healthcare problems. Here, we draw on our first 50 interviews with practising doctors employed in the NHS in areas that struggle to recruit and retain doctors, and explore the gendered nature of career biographies. We also pay attention to the ways in which doctors carve their own career pathways out of, or despite of, personal and professional disruptions.

The effect of socioeconomic status and training programmes on burnout in postgraduate trainees in the United Kingdom: a cross-sectional analysis.

Burnout is described as a state of mental exhaustion caused by one's professional life and is characterised by three domains: emotional exhaustion, depersonalisation, and a reduced sense of accomplishment. The prevalence of stress is high amongst doctors and varies by specialty, gender, trainee level, and socioeconomic status. The authors set out to examine the scale of the problem, as well as to determine the influence of both socioeconomic status and chosen training programme on burnout amongst postgraduate trainees. This would identify at-risk groups and aid in future targeted interventions. Cross-sectional data were obtained, following approval from the General Medical Council, from The National Training Survey, completed annually by all trainees in the United Kingdom. Data were then anonymised and analysed. Burnout scores were derived from the Copenhagen Burnout Inventory and are positively framed (higher scores equal lower burnout). The questionnaire was completed by 63 122 participants from 2019 to 2020. Mean burnout amongst all trainees was 52.4 (SD = 19.3). Burnout scores from the most deprived quintile was significantly lower compared with those from the least deprived quintile: 51.0 (SD = 20.6) versus 52.9 (SD = 18.9), respectively (P < 0.001). The highest levels of burnout were reported in Internal Medical Training, Emergency Medicine, Obstetrics and Gynaecology, and Core Surgical Training, respectively. Postgraduates from lower socioeconomic backgrounds are more likely to encounter burnout during training. At-risk groups who may also benefit from targeted intervention have been identified, requiring further examination through future studies.

Progress Testing in UK Medical Education: Evaluating Its Impact and Potential.

This comprehensive review critically examines the UK medical curriculum, with a particular focus on progress testing as an innovative assessment strategy. The curriculum, evolving from foundational sciences to practical applications, is encapsulated in the integrated curriculum model (ICM). This model adeptly combines theoretical knowledge with clinical practice, fostering cognitive, affective, and psychomotor skills among medical students. Central to this review is an exploration of progress testing. This method, grounded in constructivist learning theories, emphasises continuous assessment and professional development. Progress testing's regular, comprehensive examinations are instrumental in guiding students through the progressive stages of competence, as outlined in Miller's pyramid, from foundational knowledge to clinical proficiency. The review also addresses the broader impacts of progress testing on teaching approaches, student feedback, academic and pastoral support, and quality assurance. By aligning with the dynamic requirements of 21st-century medical training, progress testing not only nurtures well-rounded professionals but also ensures compliance with regulatory bodies like the General Medical Council. Its emphasis on continuous evaluation aligns with the practical realities of a medical career, driving curricular innovation and aligning with regulatory standards. The implementation of progress testing marks a significant advancement in medical education. Its continuous, holistic nature benefits both students and educators, nurturing a more engaged learning attitude and meeting evolving medical needs. The adoption of this assessment strategy is seen as pivotal in shaping competent medical professionals, ready to face the challenges of modern medical practice.

The role of medical support workers during the COVID-19 pandemic in the NHS in the UK: A qualitative service evaluation at the Oxford University Hospitals NHS Foundation Trust

We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the goals of the MSW position, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants. Results were categorised into micro-, meso-, and macro-levels of the health system. At the micro-level, MSWs were recognised as a diverse group of highly qualified international medical graduates (IMGs) who had a crucial role during the pandemic. At the meso-level, participants emphasised the importance of a comprehensive induction by the hospital, to clarify responsibilities and familiarise MSWs with the health system. At the macro-level, the role facilitated MSW integration within the NHS, with the aim of practising as doctors. The importance of comprehensive hospital induction, with role clarity for both MSWs and their teams, supportive supervision and assistance with applying for registration with the General Medical Council, were highlighted as key quality improvement areas.

Teaching Frailty to Medical Residents: A Needs Assessment Among Geriatrics Faculty.

Knowledge of frailty is essential for meeting the Accreditation Council for Graduate Medical Education core competencies for US trainees. The UK General Medical Council requires that frailty be included in undergraduate and graduate medical education curricula. Trainees are expected to appropriately modify care plans and help make patient-centered decisions, while incorporating diagnostic uncertainty, such as frailty, in older adults. Little is known about current needs for frailty instruction in graduate medical education in the US and beyond. We sought to capture faculty perceptions on how frailty should be defined and identified, and what aspects and level of detail should be taught to residents. The authors developed a 4-item short response questionnaire, and faculty had the option to respond via electronic survey or via semi-structured interviews. Respondents included 24 fellowship-trained geriatricians based at 6 different academic medical centers in a single urban metropolitan area. An invitation to participate in either an electronic survey or semi-structured virtual interview was e-mailed to 30 geriatricians affiliated with an academic multi-campus Geriatric Medicine fellowship. Responses were transcribed and coded independently by two authors. Responses were received from 24 geriatricians via a combination of digital questionnaires (n=18) and semi-structured online interviews (n=6), for a response rate of 80%. Responses revealed significant diversity of opinion on how to define and identify frailty and how these concepts should be taught. As frailty is increasingly incorporated into clinical practice, consensus is needed on how to define and teach frailty to residents.

Evaluation of the preclinical hospital visit programme with students' feedback at the University of Nottingham, UK.

Background . The General Medical Council's publication Tomorrow's Doctors recommends that medical students should attain professional awareness at an early stage of their education. Accordingly, in the University of Nottingham, basic science teaching is integrated with clinical practice, by attaching medical students to hospital specialty teams and general practices in the community, as regular timetabled 'hospital visits' from the beginning of their medical education. We evaluated the feedback forms of the preclinical (1st and 2nd years) medical students retrospectively based on their experience of the hospital-based clinical teaching programme over 2 years. The hospital visit programme was modified based on the student feedback following which the effectiveness of the modified programme was revaluated post-test. Methods . This study was based on a quasi-experimental design in which comparisons of pre-test and post-test feedbacks with 337 feedback forms in each group were analysed in the study period. Quantitative response questions in the feedback were statistically analysed using independent t-test, and free text questions were qualitatively analysed and grouped into themes. Results . Data analyses showed significant difference (p<0.001) between the pre- and post-test groups. The main feedback themes identified were number of the patients examined, organization of the visit, patient selection, introductory talk, and briefing and debriefing before and after the visit. Conclusion . The structure of the hospital visit programme was influenced by the available infrastructure, flexibility of access and delivery of clinical teaching. The programme helped build professional attitudes in both staff and students and encouraged independent learning.

Surgical trainee experiences from 2013 to 2023 within the United Kingdom as reported by the General Medical Council National Training Survey

IntroductionThe General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels. MethodsWe gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions. ResultsOf the 198 metrics analysed, 83 (42 ​%) were found to have statistically significant negative trends (P ​< ​0.05), in comparison to 24 (12 ​%) with positive trends. 5 specialities had over 50 ​% of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P ​< ​0.05). Of 141 individual training programmes, 29 ​% showed a significantly negative trend in overall satisfaction, with 1 ​% demonstrating a significant positive trend (P ​< ​0.05). ConclusionOur study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision.

Survey of United Kingdom oral and maxillofacial surgery (OMFS) specialists and trainees about the reasons that they retain or drop their registration with the General Dental Council (GDC) including a summary of changes in the numbers registered with the GDC 2014-2023

When dual degree OMFS training was mandated in the UK in 1995, OMFS specialists were required to be registered with both the General Dental Council (GDC) and General Medical Council (GMC). In 2005 this legal requirement for dual registration with both regulators was removed. During 2021 the authors surveyed UK OMFS specialists and trainees asking them why they chose to remain on or leave the Dental Register to give context to the changing numbers of OMFS specialists and trainees holding Dental Registration between 2014 and 2023. In 2014 of 539 OMFS specialists and trainees only 62 (12%) were solely GMC registered, that is, they had let their Dental Registration lapse. In 2023, of 709 OMFS specialists and trainees, 320 (45%) were solely GMC registered. Those whose first qualification was medicine were less likely to be dually registered. Of those who replied to the survey and remained dually registered, most (40%) based this decision on ‘worries about the consequences’ of dropping their dental registration. Some other reasons were not based on fact at that time. Cost was the most common reason (49%) given for dropping their GDC registration by respondents who were only registered with the GMC. On the positive side, the January 2023 GDC position statement about OMFS who are not on the Dental Register removed the GDC’s previous restriction on location of practice and teaching dental students. However the statement does not unambiguously allow OMFS surgeons to practice across the full OMFS curriculum. Will the 2023 GDC position statement alter the trend of OMFS specialists and trainees towards single medical registration?

Teaching Medical Anthropology in UK Medical Schools: Cultivating Autoethnographic Practice among Medical Students

Behavioural and social sciences (BSS) are a core component of undergraduate medical education in the United Kingdom. Despite the formal recognition of BSS by the UK’s General Medical Council (GMC), anthropology remains largely at the periphery in the medical curriculum. Medical students often describe it as ‘fluffy’ or as ‘common sense’, in comparison to biomedical learning content. To make anthropology more relevant and applicable to future clinical practice, we draw on ethnographic data (interviews, focus groups, field notes and reflective texts written by medical students) collected by an anthropologist during fieldwork in two UK medical schools. We suggest moving this content out of the preclinical phase and instead incorporating it into the clinical phase. Specifically, we propose that having students conduct a micro-autoethnography during the clinical phase brings together two crucial aspects of medical student training: BSS principles and formation of a professional identity. Embedding these concepts in this specific context will allow students to process tensions they may feel between interactions they observe in a clinical context and team versus what they have been formally taught. This process allows them to negotiate their own professional identity between practice and ideal while more robustly situating BSS content in a relevant and immediately applicable manner within the current constraints of the medical curriculum.

Audit on the Adequacy of Consenting Practices for Neck of Femur Fracture Surgeries.

Doctors are bound to obtain informed written consent prior to any form of surgical procedure on a patient. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidance on what constitutes valid consent. Failure to obtain valid and adequate consent can have legal ramifications. All relevant material risks associated with the surgery must be discussed with the patient during the consenting process. This was a retrospective cross-sectional study of the consenting practices for neck of femur fracture surgeries, covering a period of three months, from the 15thof April to the 15thof July 2023. We evaluated the consent forms of 100 patients, of which 63 were consent form-1 and were included in the study. The British Orthopaedics Association (BOA)-endorsed consent forms, together with the RCS and GMC guidance on consent, which were used as the standard for the audit. The majority of the consents were obtained by senior house officers (SHO) and core surgical trainees who did not have prior formal orthopaedic training (52.4%). The risks that were most frequently documented were infection, blood clots (deep vein thrombosis and pulmonary embolism), and bleeding, with documentation rates of over 90%. Prosthetic joint dislocation following hemiarthroplasty or total hip replacement was not mentioned in 22.2% of the forms. Neurovascular injury was not documented in 20.6% of the consent forms. Less than 75% documentation rates were observed for postoperative pain (74.6%), anesthetic complications (73%), failure (malunion/non-union/loosening of prosthesis) (68.3%), leg length discrepancy (60.3%), bone damage/fracture (50.8%), death (49.2%), wound-related complications/scars (42.9%), and hip stiffness (14.3%). None of the patients had been advised about the probable need for catheterization following surgery. We also noted that 22.2% (n=14) of the consent forms did not contain the diagnosis or the indication for surgery, 12.7% (n=8) did not mention the intended benefits, and 28.6% (n=18) of the consent forms had no mention of the responsible consultant.We also noted that in 25.4% (n=16) of the cases, the possible requirement of a blood transfusion had not been mentioned. The audit revealed several deficiencies in the consenting of patients for neck and femur fracture surgeries. There were poor documentation rates for risks associated with surgery, especially the less common and rare ones. We also identified several deficiencies in the remaining aspects of the consent forms that were not in keeping with the GMC and RCS guidance on consent. The lack of orthopaedic training and knowledge among the senior house officers and core trainees may be a contributing factor.

The negative impact of global health worker migration, and how it can be addressed

International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.

Challenge of achieving truly individualised informed consent in therapeutic endoscopy

ObjectiveGuidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks...