Hull York Medical School Research Articles

Confronting racism as a healthcare challenge: A teaching and learning approach

Across the United Kingdom, medical schools are acknowledging the need to respond to inequalities experienced by minority groups, racism within healthcare, and the need to decolonise medical curricula. Understanding the impact of structural racism is increasingly recognised as part of health professionals’ training. In this paper we report the delivery of a new lecture and workshop on racism to first year medical students at Hull York Medical School, aimed to teach students about structural racism and the impact it has on health and healthcare services. Whereas comparable training programmes focus on personal values of inclusivity and diversity, these sessions encourage students to consider the reality of racism as part of health and healthcare experiences. The session includes conceptual content alongside applied examples of microaggression experienced by a healthcare professional. We report the results of student feedback attained through surveys using Likert scales and free text. We conclude by discussing the benefits of teaching medical students about racism, and its impact on patients and staff, rather than just inclusive practice.

Myth of the QANTAS leap: perspectives on the evolution of kangaroo locomotion

The distinctive QANTAS ‘flying kangaroo’ motif of Australia’s national airline signifies what many people regard as the pinnacle of kangaroo evolution—a large-bodied marsupial specialized for endurance-hopping. However, while almost all extant macropodoids (the crown group including kangaroos) use hopping gaits to some extent, the fossil record reveals that the locomotory capabilities of extinct macropodoids were comparatively diverse. The earliest recognized Oligocene–middle Miocene macropodoids probably employed quadrupedal bounding, climbing and slower speed hopping as their primary modes of locomotion. Yet, all were apparently small-bodied (<12 kg), with larger-bodied (>20 kg) forms not appearing until the late Miocene coincident with increasing aridity and the spread of openly vegetated habitats. Hopping is functionally problematic at larger body sizes. Consequently, the later radiation of macropodids (kangaroos, wallabies and their relatives) achieved an optimal mass for efficient higher-speed hopping at ∼35 kg, with a theorized extreme limit of ∼140–160 kg. Modern kangaroos otherwise approach the peak mass range for such gaits at ∼50–90 kg, with the gigantic Pliocene–Pleistocene species of Protemnodon (‘giant wallabies’) at ∼100–160 kg likely being predominantly quadrupedal, and sthenurines (short-faced kangaroos) at ∼50–250 kg seemingly using bipedal striding. Here, we review the fossil evidence of macropodoid locomotion over the last ∼25 million years, and present preliminary analyses of limb bone and tarsal metric data. These indicate that the higher-speed endurance-hopping typical of modern large-bodied kangaroos was probably rare or absent in all but a few crown macropodoid lineages. The intrinsic gait variability of macropodoids has therefore diminished with Late Pleistocene megafaunal extinctions. As a result, the famous QANTAS ‘flying kangaroo’ actually depicts only one of what was once many successful locomotory strategies employed by macropodoids to conquer a range of terrestrial and arboreal habitats.Christine M. Janis [christine_janis@brown.edu], Bristol Palaeobiology Group, School of Earth Sciences, University of Bristol, Bristol BS8 1RJ, UK; Adrian M. O’Driscoll [aod523@york.ac.uk], Centre for Anatomical and Human Studies, Hull York Medical School, University of York, York YO1O 5DD, UK; Benjamin P. Kear [benjamin.kear@em.uu.se], The Museum of Evolution, Uppsala University, Norbyvägen 16, Uppsala SE-75236, Sweden.

O.O.8.5 - How effective are video animations in practitioner education? A systematic review of trials: Presenter(s): Nadia Benhebil, Hull York Medical School, United Kingdom

O.O.8.5 - How effective are video animations in practitioner education? A systematic review of trials: Presenter(s): Nadia Benhebil, Hull York Medical School, United Kingdom

Submental island flap - should we be worried about lymph node transfer? An anatomical and histological study

The submental island flap has been increasing in popularity for both oncological and non-oncological reconstruction of the head and neck. However, the original description of this flap left it with the unfortunate designation as a lymph node flap. There has thus been significant debate on the oncological safety of the flap. In this cadaveric study the perforator system suppling the skin island is delineated and the lymph node yield of the skeletonised flap is analysed histologically. A safe and consistent approach to raising the perforator flap modification is described and the pertinent anatomy, and an oncological discussion with regards to the submental island perforator flap histological lymph node yield discussed. Ethical approval was received from Hull York Medical School for the anatomical dissection of 15 sides of cadavers. 6 x 4cm submental island flaps were raised following a vascular infusion of a 50/50 mix of acrylic paint. The flap size mimics the T1/T2 tumour defects these flaps would usually be used to reconstruct.The submental vascular anatomy, including length, diameter, venous drainage patterns, and the skin perforator system was documented. The dissected submental flaps were then histologically examined for the presence of lymph nodes by a head and neck pathologist at Hull University Hospitals Trust department of histology. The total length of the submental island arterial system, the distance from where the facial artery branches off from the carotid to the submental artery perforator entering the anterior belly of digastric or skin, averaged 91.1mm with anaverage facial artery length of 33.1mm and submental artery of 58mm. Vessel diameter for microvascular reconstruction was 1.63mm for the submental artery and 3mm for the facial artery. The most common venous anatomy drainage pattern was the submental island venaecomitantes draining to the retromandibular system then to the internal jugular vein. Almost half the specimens had a dominant superficial submental perforator allowing the ability to raise this as a skin only system. There were generally 2-4 perforators passing through the anterior belly of digastric to supply the skin paddle.73.3% (11/15) of the skeletonised flaps contained no lymph nodes on histological examination. The perforator version of the submental island flap can be safely and consistently raised with inclusion of the anterior belly of digastric. In approximately half the cases a dominant superficial branch allows for a skin only paddle. Due to the vessel diameter, free tissue transfer is predictable.Venous anatomy is variable and care needs to be taken when raising this flap. The skeletonised version of the perforator flap is largely devoid of nodal yield and on oncological review a 16.3% recurrence rate is equivalent to current standard treatment.

Information Provision for Stroke Survivors and Their Carers: Cochrane Review

HomeStrokeVol. 53, No. 7Information Provision for Stroke Survivors and Their Carers: Cochrane Review No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextInformation Provision for Stroke Survivors and Their Carers: Cochrane Review Thomas F. Crocker, MA, MSc, PhD, Lesley Brown, PhD, Natalie Lam, PGDip, MPH, Faye Wray, MSc, PhD, Peter Knapp, RGN, BA, PhD and Anne Forster, BA, PhD Thomas F. CrockerThomas F. Crocker Correspondence to: Thomas F. Crocker, MA, MSc, PhD, Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7450-3143 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Lesley BrownLesley Brown https://orcid.org/0000-0001-5499-9145 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Natalie LamNatalie Lam https://orcid.org/0000-0001-8591-444X Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Faye WrayFaye Wray https://orcid.org/0000-0001-9351-5019 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author , Peter KnappPeter Knapp https://orcid.org/0000-0001-5904-8699 Department of Health Sciences, University of York, the Hull York Medical School, United Kingdom (P.K.). Search for more papers by this author and Anne ForsterAnne Forster https://orcid.org/0000-0001-7466-4414 Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom (T.F.C., L.B., N.L., F.W., A.F.). Search for more papers by this author Originally published27 Jun 2022https://doi.org/10.1161/STROKEAHA.121.038162Stroke. 2022;53:e269–e270"Information Provision for Stroke Survivors and Their Carers: Cochrane Review." Stroke, 53(7), pp. e269–e270FootnotesFor Sources of Funding and Disclosures, see page e270.Correspondence to: Thomas F. Crocker, MA, MSc, PhD, Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom. Email tom.[email protected]nhs.ukReference1. Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers.Cochrane Database Syst Rev. 2021; CD001919. doi: 10.1002/14651858.CD001919CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 2022Vol 53, Issue 7 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.121.038162 Originally publishedJune 27, 2022 Keywordsstroke rehabilitationanxietyconsumer health informationeducationsurvivorsPDF download Advertisement SubjectsMeta AnalysisRehabilitationSecondary Prevention

Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): protocol for a co-design and feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care

IntroductionDelirium is a complex condition in which altered mental state and cognition causes severe distress and poor clinical outcomes for patients and families, anxiety and stress for the health professionals...

Factors Associated with Rehospitalisation for Cellulitis and How to Mitigate Against Them

Gavin Barlow, Hull York Medical School, UK, spoke with the EMJ about risk factors for the bacterial infection cellulitis, including prior history of the condition, older age, and a number of comorbidities ranging from diabetes to athlete’s foot. Following hospitalisation, readmission for cellulitis, which occurs in around 12% of patients in the first month, may be due to such risk factors, as well as socioeconomic conditions. Readmission can greatly impact healthcare utilisation in economic and infection control terms and the use of sparse facilities, such as side-room beds. It can also impact a patient’s quality of life (QoL). Mitigating against readmission for cellulitis necessitates an understanding of the reasons for such, including risk factors, and how best to control them by, for instance, giving proper healthcare provision for comorbidities and educating patients to raise awareness of the recurrence of cellulitis.

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study.

BackgroundBedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students’ confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods.ObjectiveTo mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19–safe environment using SimMan 3G.MethodsFour clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session.ResultsIn total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature.ConclusionsBedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.

P49 Exploring medical student confidence in social media health advocacy through the lens of a pandemic

IntroductionSocial media facilitates the rapid spread of information and misinformation to the public. Medical students as healthcare professionals in training have a responsibility to support public health advocacy. As such, it is important to understand whether medical students feel comfortable to use social media as a tool to promote public health. There is little literature evaluating this. The covid-19 pandemic gives us a unique opportunity to characterise this relationship.MethodsThis is a cross sectional survey-based study run by the student surgical society at Hull York Medical School. Data will be collected on confidence of medical students in receiving, appraising and resharing information on social media. The study will first be run as a single centre study. Following data collection and analysis, will be promoted to other student surgical societies across the UK to be run as a collaborative national study.Results Primary ObjectiveHow confident are medical students in receiving, appraising and resharing information they receive on social media?: Secondary Objective: Is there a relationship between years of training or postgraduate/undergraduate status and confidence in using social media amongst medical students? How often do medical students use social media as their primary source of information? Is there adequate education on how social media can be used to combat misinformation?: Conclusion: The covid-19 pandemic allows a unique opportunity to characterise the relationship between medical students, social media, and health advocacy. Understanding this relationship will help guide medical education to incorporate social media as an effective tool in healthcare.

Integrated miRNA/Cytokine/Chemokine Profiling Reveals Severity-Associated Step Changes and Principal Correlates of Fatality in COVID-19

Inflammatory cytokines and chemokines (CC) drive COVID-19 pathology. Yet, patients with similar circulating CC levels present with different disease severity. Here, we determined 171 microRNAomes from 58 hospitalised COVID-19 patients (Cohort 1) and levels of 25 cytokines and chemokines (CC) in the same samples. Combining microRNA (miRNA) and CC measurements allowed for discrimination of severe cases with greater accuracy than using miRNA or CC levels alone. Severity group-specific associations between miRNAs and COVID-19-associated CC (e.g. IL6, CCL20) or clinical hallmarks of COVID-19 (e.g. neutrophilia, hypoalbuminemia) separated patients with similar CC levels but different disease severity. Critically, analysis of an independent cohort of 108 patients from a different centre (Cohort 2) demonstrated feasibility of CC/miRNA profiling in leftover blood samples with similar severe disease CC and miRNA profiles, and revealed CCL20, IL6, IL10, and miR-451a as key correlates of fatal COVID-19. These findings highlight that systemic miRNA/CC networks underpin severe COVID-19.Funding: The study was funded by the UKRI MRC/NIHR award to the UK Coronavirus Immunology Consortium (UK-CIC, MR/V028448/1). Sample collection at Manchester NHS Trusts was supported by the NIHR Manchester Biomedical Research Centre (TH and AS) and 3M Global Giving award (JRG and TH). Sample collection at York and Scarborough NHS Trust was supported by the Wellcome Trust (ISSF grant WT204829 through the Centre for Future Health at the University of York) and the Hull York Medical School. JRG is supported by a senior fellowship by The Kennedy Trust for Rheumatology Research. This report contains independent research supported by the North West Lung Centre Charity and the NIHR Manchester Clinical Research Facility at Wythenshawe Hospital.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: For the cohort 1, ethics approval was obtained from the North West-Haydock Research Ethics Committee for ManARTS (reference 15/NW/0409) and from the Wales Research Ethics Committee 4 for NCARC (reference 18/WA/0368). For the cohort 2, ethics approval was obtained from Yorkshire & The Humber - Leeds West Research Ethics Committee (REC reference 19/YH/0394 with approved 26 SA002 amendment of IRAS project 269597).

The two heads of a simulated patient – maximizing their use in communication training

ABSTRACT Background Simulated patients (SPs) are an established resource in medical communication training where they portray patients with medical problems to allow medical students to practice communication skills. The range of skills offered by SPs appears to be underappreciated and there is no formal published research exploring their views on how their skills can best be utilized in experiential teaching sessions. This study aims to fill that research gap. Methods Eighteen SPs from two medical schools, Hull York Medical School and Durham University, were interviewed using an in-depth, one-to-one, semi-structured approach. Data was transcribed verbatim and thematically analysed. Results Three global themes were identified from the data: (i) the benefits of using simulated patients, (ii) prerequisites and (iii) feedback. Benefits of using SPs include their ability to target specific communication skills in role-play. They can facilitate sessions and give feedback to students; and they enable early communication training in a non-clinical setting. Their key asset is the ability to role-play a realistic patient whilst simultaneously appraising the student’s performance and adapting their role to create learning opportunities. We have named this dual approach the two heads of an SP. There are certain essential prerequisites. SPs and tutors need appropriate training. Students should be encouraged to be themselves and engage in consultations. A close SP-tutor relationship is beneficial. For SPs giving feedback to students, a priority is to build student confidence. Views on the use of in-role feedback were polarized. Conclusion This study explores SPs’ views on the skills they offer in medical communication training and how these can be best utilized, providing valuable learning points for medical educators.

Prescription of oral anticoagulation for stroke prophylaxis in atrial fibrillation according to frailty status: a national study of 536,995 primary care records

Abstract Background At least 10 million people in Europe have a diagnosis of atrial fibrillation (AF). People with AF commonly have concomitant frailty, rendering them vulnerable to various adverse outcomes. Whilst appropriate prescription of oral anticoagulation (OAC) is associated with reduced risk of stroke and mortality, there are fears of iatrogenic harm in older people with frailty. Purpose Previous studies give conflicting evidence of the association between frailty and OAC prescription and are based on small samples from select cohorts. Therefore, we provide data of the association between OAC prescription and frailty for a large representative cohort of patients with AF. Methods This cross-sectional study used EHR for 536,955 patients in England aged ≥65 years on 31/12/2015. Clinical Terms Version 3 (CTV-3) codes were used to identify AF and relevant past medical history (PMH, including: cancer, varices, intracranial or gastrointestinal haemorrhage). Frailty was determined according to the validated electronic frailty index (eFI, a cumulative deficit score of 36 possible deficits), and categorised into robust (0–0.12), mild (&amp;gt;0.12–0.24), moderate (&amp;gt;0.24–0.36) or severe (&amp;gt;0.36) frailty. Patients with a CHA2DS2-VASc score of ≥2 were considered eligible for OAC prescription. Prescription of OAC among those eligible (warfarin or direct oral anticoagulant [DOAC]) or not was established using prescribing data within the EHR. Poisson regression modelling was used to determine the odds of OAC prescription for each frailty category compared with non-frail (robust) individuals. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported with and without adjustment for sex, deprivation, PMH, concomitant prescription of medications that increase bleeding risk (including antiplatelets, steroids, non-steroidal anti-inflammatories). Results Of the cohort, 61,177 (11.4%) had AF. Of these, 58,204 (95.1%) were eligible for OAC, which was prescribed in 30,916 (53.1%) people. Individuals prescribed OAC were on average 5 months younger than those not prescribed OAC (80.1 vs 80.5 years, p&amp;lt;0.001), and had a slightly higher CHA2DS2-VASc score (4.0 vs 3.8, p&amp;lt;0.001). Frailty was identified in 54,734 (89.5%) patients with AF. OAC was prescribed in 2,028 of 4,863 (41.7%) patients in the robust category; 10,221 of 19,198 (53.2%) with mild; 11,167 of 20,099 (55.6%) with moderate; and 7,500 of 14,044 (53.4%) with severe frailty. In comparison to the robust category, frailty was associated with higher odds of OAC prescription: mild frailty OR 1.6 (95% CI 1.5 to 1.7); moderate 1.7 (1.6 to 1.9); severe 1.6 (1.5 to 1.7). Adjustment for confounding variables increased the magnitude of the association (Figure 1). Conclusion People with AF and advancing frailty were more likely to be prescribed an anticoagulant than those with AF who are robust. Specific safety and efficacy data for OAC are needed in people with AF and frailty to better inform clinical decision-making. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): CW was funded by the Hull-York Medical School. He is now an NIHR clinical lecturer.

The Optimal Course Duration for Antibiotic Prophylaxis in the Prevention of Surgical Site Infection in Major Lower Limb Amputations: A Randomised Controlled Trial

Background: Major LLA remains a common operation in the United Kingdom with ⁓5000 procedures performed yearly. Amputations are described as ‘clean surgery’ and SSIs in this patient cohort have been previously under-reported. The true incidence lies between 13-35% and is associated with patient mortality, morbidity and implications on health economics. Previous work done in this thesis has demonstrated lack of consensus in clinical practice regarding perioperative antibiotic prophylaxis, and lack of high-quality studies to formulate and sustain a common practice across the UK. Methods: A single centre RCT was designed to which a total of 161 patients were recruited and randomised to receive either a 5-day or a 24-hour prophylactic antibiotic course. Within the groups further allocation to skin preparation (alcoholic chlorhexidine Vs. alcoholic povidone iodine) was performed by stratification. Results: A total of 152 patients were included in the final analysis. Groups were well matched for comorbidities and demographics. The use of a 5-day course was associated with a statistically significant lower incidence of SSI(n=9, 11.8%) when compared to the 24-hour group (n=30, 39.5%) (P<0.001) and lower incidence of IWH(n=17, 22.4% Vs. n=44, 57.9% respectively) (P<0.001). The level of amputation was the only other statistically significant independent factor associated with an increase in SSI incidence (P=0.018, P=0.005, and P<0.001 respectively). Choice of skin preparation between alcoholic chlorhexidine and povidone iodine had no effect on the incidence of SSI / IWH. The presence of SSI statistically significantly increased the post-operative length of hospital stay (from median 14 to 28 days, P=0.0125) Conclusions: This is a Level 1 study which demonstrated that the use of a 5-day over a 24- hour antibiotic course can significantly reduce incidence and risk of SSI/IWH development. It has also highlighted another independent factor, the level of amputation. The presence of SSI is associated with prolonged hospital stay, something which has significant implications on patient morbidity as well as incurring significant costs on healthcare resources. Trial Registration: The protocol was registered online as EudraCT Number: 2012- 003146-32 Funding Statement: Internal University funding only (Hull York Medical School, UK) Declaration of Interests: None Ethics Approval Statement: All necessary national and local ethics board approvals were obtained.

Not all who wander are lost: evaluation of the Hull York medical school longitudinal integrated clerkship

ABSTRACT Longitudinal integrated clerkships (LICs) are increasingly available within the United Kingdom, but gaps in knowledge remain regarding their efficacy and the influence of local context. In 2019–20, the Hull York Medical School ran a pilot LIC for 6 fourth-year medical students. This work describes the longitudinal qualitative programme evaluation. LIC students participated in two focus groups, one after four months, and another at the end of the programme. In total, 16 faculty were also interviewed regarding their experiences in developing, implementing and running the LIC. Students’ GP supervisors were difficult to engage in detailed evaluation due to the COVID-19 pandemic, and so were briefly surveyed at the end of the LIC. All data were pooled and analysed together using reflexive thematic analysis. Two major themes were identified: ‘Trajectory of the LIC’, describing the learning curve students and faculty encounter, and ‘Institutional decision making’, describing the need for clarity regarding the programme’s purpose. The programme was largely positively received, but areas for improvement locally, and transferrable recommendations, were identified. Aligning assessment to programme aims is an important area for future development, alongside balancing structured with unstructured time, and supporting students as they navigate a J-shaped learning curve.

#pandemicpedagogy: Using Twitter for knowledge exchange.

The COVID-19 crisis has resulted in homeworking becoming the norm internationally. As a result, international, national and institutional medical education conferences, workshops and seminars have been cancelled or postponed indefinitely. Consequently, the opportunity for knowledge exchange and networking has been reduced. Hull York Medical School runs a medical education research unit with associated masters and PhD programmes that rely on conferences as opportunities for postgraduate students to learn from others in the field, showcase their research and innovative pedagogy, as well as network for future employment.

Commitment towards a better future for medical education in Saudi Arabia: the efforts of the college of medicine at Qassim University to become socially accountable

ABSTRACT Background: The College of Medicine at Qassim University (COMQU) was founded in 2001 as a problem-based learning and community-oriented medical school in order to strengthen the health system not only in the Qassim region but also in the whole of Saudi Arabia. The aim of the current study was to assess whether the COMQU is a socially accountable medical school and the steps taken to achieve that target. Materials and methods: The study used the social accountability grid published by the World Health Organization (WHO) as a framework to assess the social accountability efforts in the context of three functions of medical schools: education, service and research. Data were collected through the analysis of college documents (2001–2017) and interviews with key informants. Results: The COMQU shows compliance towards social accountability in the three domains of the grid. The indicators related to the education domain demonstrate more compliance than those of research and community service in the grid. Conclusion: The COMQU is based on community-oriented medical education (COME) with strong commitment towards social accountability (socially responsible going towards social responsiveness). More research is needed in order to pave the way to achieve social accountability status. Abbreviations: COMQU: College of Medicine at Qassim University; COME: Community-oriented medical education; WHO: The World Health Organization; MOH: Ministry of Health; SCFHS: Saudi Commission of Health Specialties; PHC: Primary Health Care; HYMS: Hull York Medical School; WFME: World Federation for Medical Education; NCAAA: National Commission for Academic Accreditation and Assessment

Meet the First Authors.

Meet the First Authors.

Should Black Humor Be Put To Death? Examining Student and Staff Views on Black Humor in Anatomy Labs

Beyond studies and discussions regarding learning outcomes related to dissection, prosection, and anatomy lab experiences, there has been a recent increase in examining the role of the ‘hidden curriculum’ in anatomy education. Lab experiences of many types can help foster professionalism and more humanistic views towards donors, and eventually patients, via this integrated hidden curriculum. But what has been overlooked are the potential darker aspects of the hidden curriculum that may begin in anatomy labs. While the days of ‘cadaver antics' and directly objectifying donor bodies are no longer tolerated, there is little research regarding the more subtle use of dark humour and language still present in anatomy education. Thus, our study aims to better understand the use of black, or cynical, humour as a component of the hidden curriculum of anatomy labs. An Ethics‐reviewed study was designed, and participants were recruited from the Hull York Medical School to voluntarily complete an online survey comprised of 3 demographic, 5 open‐ended, and 6 rating‐scale items. Eligible participants included medical students, MSc anatomy students, anatomy lab tutors, and anatomy faculty. Responses were analysed by descriptive statistics, and open‐ended questions were coded for common themes. Data continues to be collected and analysed, but preliminary findings suggests there are certain themes regarding the perceived appropriateness of black humour in medical education settings. Our findings suggest that the themes of context and situation of humour are key in determining appropriateness, and that while some participants express discomfort at the use of black humour, humour in the anatomy lab is more widely regarded as an appropriate means of coping with stress. An additional emergent theme is the use of (cynical) humour to promote camaraderie amongst teammates. While our data analysis is still ongoing, the preliminary themes suggest outcomes of this study may have implications for better understanding how to address the darker hidden curriculum of anatomy. Additionally, we hope that our findings help to further develop best practices for fostering humanistic future practitioners, throughout all levels of medical training, but starting in anatomy labs with students' ‘first patients.’This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Editorial introductions

Editorial introductions

Medical communication: the views of simulated patients.

Simulated patients (SPs) are extensively used in the teaching of medical communication, both for students and doctors. They occupy a unique middle ground between patients and physicians: although free from the prejudices that medical training brings, they work closely with clinical tutors to promote the principles of patient-centred consulting. Despite this, there is relatively little research around their views on what makes for good communication practice. This study aims to address this gap in the literature through a qualitative analysis of SPs' opinions, especially in the context of medical student communication. Eighteen SPs from two medical schools, Hull York Medical School and Durham, were interviewed, using an in-depth, one-to-one, semi-structured approach. Data, transcribed verbatim, were thematically analysed. Three global themes were identified: (i) listening and empathy and showing it, (ii) continual human connection and (iii) information flow from the patient. These three themes, termed the communication triad, form a type of virtuous circle, each facilitating the other. Listening and empathy were facilitated through attributes, including attentive non-verbal communication, and through responding to cues, including making effective empathetic statements. Continual human connection was facilitated through successful beginnings, including preferring open questions to 'robotic' tick-list questions and allowing patients time to have their say. Mirroring, professional appearance, appropriate physical contact and a human approach were amongst other factors facilitating connection with patients. Information flow was encouraged by factors including showing an interest in the patient and use of silence; flow was curtailed by undesirable attributes, including interrupting, dismissive communication and making assumptions about aspects such as sexuality. This first in-depth study of SPs' views on medical consulting identifies a communication triad that both affirms and builds on the current literature base. Five novel teaching points emerge, with clear relevance for best practice communication teaching and curricula design.