Medical Council Research Articles

Navigating Through the Newer Components of the Indian Competency Based Medical Education

Background: The one thought that has taken precedence over the conscious cognition of the cerebral cortex of Indian medical educators is how to implement the Competency Based Medical Education (CBME) program. A revolution that has occurred after 21 odd years, indeed should captivate the change leaders of health professions education. COVID -19 pandemic has posed on medical educators, who enthusiastically implemented the CBME curriculum from 2019 in India, an uphill struggle to understand, apply and eradicate the challenges in effectively implementing the newer elements of the CBME curriculum. A number of newer elements namely Foundation course, Early Clinical Exposure, Electives, Integration, and Learner Doctor Method of clinical clerkship, have been introduced into the new undergraduate medical curriculum. Health professions educators in India, being beginners in implementing these newer elements of the revolutionary 2019 CBME curriculum, it is pertinent to answer the queries that tickle the minds on how to implement and address the anticipated challenges and where to look for solutions. Aims: The authors aim to address some of these queries by giving ready to use templates, guided stepwise breakup of implementation, experience based solutions to the challenges, for various newer elements. They elaborate upon the opportunities of a positive change that medical education in India so direly needs. Conclusion: The stumbling blocks in implementing such a dynamic and thoroughgoing program needs the due contemplation to navigate successfully as directed by the National Medical Commission or erstwhile Medical Council of India. Keywords: Foundation course, Electives, Integration, Early clinical exposure, Clinical clerkship

1424. Central Nervous System Tuberculosis in a Large Healthcare System

Abstract Background Central nervous system tuberculosis (CNS-TB) accounts for 5-10% of extrapulmonary TB cases. It takes 3 clinical forms: meningitis, tuberculoma, and arachnoiditis. Modern case descriptions of the presentation of CNS-TB are rare. The goal of this study is to examine the presentation, diagnostic studies, and associated comorbidities of CNS-TB. Methods In our academic healthcare system, cases of culture confirmed CNS-TB were identified in a database maintained by the infection control group. This is a retrospective case series of the 11 adults with confirmed CNS-TB. Results 273 patients were identified with TB infection from 2008 to 2022. 104 (38%) had extra pulmonary disease. 11 (4%) had CNS infection. Patient characteristics are described in Table 1. 5 (45%) of the patients with CNS disease also had pulmonary disease. Mean age of diagnosis was 42. 5 (45%) were male and 9 (82%) were African American. 5 (45%) had HIV; mean CD4 count was 100 (8-255). Diagnostics are shown in Table 2. CSF studies revealed a mean WBC of 295/mm3 (4-808), protein of 605 mg/dL (27-4476), and Glucose of 31 (12-64) mg/dL. 4 (36%) patients presented with British Research Medical Council (BMRC) clinical stage I disease and 7 (64%) with stage II disease. 8 (73%) patients had an abnormal CT or MRI scan of the head, with representative images seen in Figure 1. 5 patients (45%) had lesions consistent with tuberculomas. 1 (9%) had arachnoiditis identified on imaging. 1 (9%) patient died. Conclusion 38% of patients diagnosed with TB at our center had extrapulmonary disease compared to 17.5% reported in the literature. The 4% rate of CNS-TB was similar to previously reported. Our series describes abnormal imaging as well as CSF studies showing leukocytosis, pleocytosis, and hypoglycorrhachia consistent with previously described findings. Though numbers were small, no significant difference was found between HIV positive and negative patients. Although mortality was rare in our series, the patient who died had advanced AIDS and multidrug resistant meningitis. Given the significant global mortality of this disease, this series highlights the need for more current studies describing the presentation and diagnostic characteristics of modern CNS-TB so clinicians can better recognize and treat the condition without delay. Disclosures All Authors: No reported disclosures.

Harnessing the potential of practice-based clinical optometry research in the United Kingdom.

Research is the core of evidence-based practice across all healthcare, in order to ensure optimum patient care. The College of Optometrists is a national standard setting institution for optometric practice in the United Kingdom. However, the standards are only as good as the available evidence, and currently there is little evidence relating directly to optometric practice. The National Institute of Health and Care Research, the General Medical Council and The College of Optometrists, amongst others, have published research strategies describing ambitious plans to expand the scope of healthcare research. The aim of this article is to raise awareness of these government initiatives and consider how they may relate to optometric practice. To improve optometrist research engagement, we need to address the barriers to research and implement strategies to overcome them. There are many opportunities to support research, with different degrees of involvement, from signposting patients to research studies, supporting recruitment or collecting data for a multicentre clinical trial, as well as undertaking an individual research project. Healthcare research is changing and there is scope for more practice-based research activities in optometry. Research should not be a solo endeavour but a multi-disciplinary effort. Greater collaborations across all stakeholders, including primary care, secondary care, academia, regulators and industry is needed to make this possible.

National Education Policy 2020 and Challenges to the Bar Council of India

Every field of higher education, including the arts, social sciences, physical sciences, technology, and law, as well as every form of education, whether general, professional, or technical, has something to ‘take’ from the National Education Policy (NEP) 2020. This is the first time in the history of the National Education Policy that legal education is referenced within the context of higher education. All stand-alone universities, such as National Law Universities, must be turned into multidisciplinary universities under Policy 2020. By 2030, all institutions that provide professional or general education will strive to organically evolve into institutions that provide both fluidly and integrated manner. The Policy called for the complete abolition of the affiliation system and the conversion of affiliated institutions into either constituent colleges of the university under the direct management and control of the university or autonomous multidisciplinary degree conferring colleges, or for a few affiliated colleges to be bundled together through mergers and acquisitions and then converted into either autonomous institutions or universities, and affiliated colleges in phase manner will be converted into autonomous colleges. Under the NEP 2020, there will be a single regulatory structure for all forms of education, with the exception of medical and legal education. However, the Policy did not establish or mention a distinct regulator for law and medicine. Whereas the National Medical Commission (NMC), the successor to the Medical Council of India, was established to regulate medical education, the Bar Council of India (BCI) was established by the Advocates Act solely to establish a professional body for practising advocates (Bar Council of India and States). If the BCI is to function as a regulatory body for legal education, it must walk a mile in order to implement the NEP 2020 for all stages of legal education, undergraduate, postgraduate, and research studies, as well as for all types of education, academic, professional, and clinical skill learning. Assuming that the deadline specified in the NEP 2020 is final and that a new shape of education is required under the NEP, BCI will need to emphasize what needs to be done and then how such changes in all levels can be accomplished within the timeframe!

Planetary health and sustainability teaching in UK medical education: A review of medical school curricula

Background The doctors of the future need to be empowered to deliver healthcare sustainably while protecting their patients’ health in the context of a degrading environment. This study aimed to objectively review the extent and nature of the teaching of planetary health and sustainability topics in UK medical education. Methods A multi-centre national review of the timetabled teaching sessions in medical courses in the UK during the academic year 2020/2021 against the General Medical Council’s adopted ‘Educating for Sustainable Healthcare – Priority Learning Outcomes’. Medical students were recruited and reviewed the entirety of their own institution’s online teaching materials associated with core teaching sessions using a standardised data collection tool. Learning outcome coverage and estimated teaching time were calculated and used to rank participating medical schools. Results 45% of eligible UK medical schools were included in the study. The extent of teaching varied considerably amongst courses. Mean coverage of the 13 learning outcomes was 9.9 (SD:2.5) with a mean estimated teaching time of 140 min (SD:139). Courses with dedicated planetary health and sustainability sessions ranked best. Conclusion There is large disparity in the education that medical students receive on these topics. Teaching may not adequately prioritise sustainability or reflect advances in planetary health knowledge. Practice points Medical education on planetary health and sustainability topics varies widely amongst UK medical schools. UK medical education does not necessarily reflect recent advances in planetary health knowledge. Greater educational focus is required on sustainability in healthcare. Centrally mandated teaching on these topics may improve disparity in education. This study’s methodology provides a possible approach for future curriculum evaluations.

Improving the documentation of chaperones during intimate examinations in a surgical admissions unit: A four-stage approach.

The General Medical Council (GMC) states that all intimate examinations should have a chaperone offered. Documentation of chaperone identity, or patient's refusal, is essential. This project aimed to improve documentation of chaperones during intimate examination of patients based in a Surgical Admissions Unit (SAU) within a large tertiary hospital in the Southwest of the UK. A Plan-Do-Study-Act (PDSA) cycle structure was used. Initial data collection and planning occurred in December 2019. Intervention implementation and analysis occurred from January 2020 to March 2021. Intervention 1 involved presenting results at a clinical governance meeting. Intervention 2 was information posters in the SAU and intervention 3 involved training sessions for nursing staff. Intervention 4 was editing the surgical clerking proforma. Prior to interventions, chaperone identity or patient's refusal was correctly documented only 9.7% (N = 7 out of 72) of the time. Intervention 1 increased this to 34.6%. Following interventions 3 and 4, correct documentation was 25.0% and 28.6% respectively. After intervention 4 correct documentation was at 59.1%. Initial documentation of chaperones was poor. Interventions 1 to 3 were successful in educating clinicians how to document accurately, but engaging individuals in person was more successful than passive education through posters. Changing the proforma structure was the most successful intervention. This suggests a visual reminder for clinicians at the point of contact with the patient is the most effective way to encourage correct documentation of chaperones, improving patient care and clinical practice.

Quality in postgraduate medical education: hearing the trainee voice and beyond

Most doctors in training will have completed the annual General Medical Council training survey, but what happens to the results and how do they lead to improvement in the quality of training? This article discusses the General Medical Council survey and potential ways in which the assessment of quality in postgraduate medical training could be improved.

"Technology Proficiency" in Medical Education: Worthiness for Worldwide Wonderful Competency and Sophistication.

Advances in bioinformatics, information technology, advanced computing, imaging techniques are changing fundamentally the way physicians define, diagnose, treat, and prevent disease. New disciplines - Artificial Intelligence, Machine Learning, Computational Biology - are improving healthcare. Digital health solutions have immense scope. Education and practice need to keep pace. We aimed at assessment of "Technology proficiency" required by medical graduates and its implementation, if found useful. All this in a conceptual framework of "TP" model, having categories (a) proper assessment (b) pertinent treatment (c) progress monitoring (d) prevention applications (e) professional standards. A search of the literature was performed using MedLine & Cochrane Central Register of Controlled Trials databases, for systematic reviews and meta-analysis articles published in the last five years using keyword "technology". Analysis of those relevant to the role all medical graduates should play. An analysis of worldwide statutory medical institutions guidelines. Twenty-three systematic studies and meta-analysis were studied. Eighteen show clear evidence for 'Technology proficiency", while 5 recommend further studies. The findings are discussed suiting the roles of doctors in the "TP" model. Medical institutions guidelines worldwide diligence suggests need of including "Technology proficiency" as a definite and distinct strategic plan. Medical Council of India mandates "use information technology for appropriate patient care and continued learning". General Medical Council, UK and Medical Council India have been proactive in technology training. GMC recommends technology use for learning, prescribing, communication, and interpersonal skills. It should be expanding technology proficiency in practice as an essential professional capability. "Technology proficiency" is found pertinently fruitful. It should be included as a definitive requirement and a distinct strategic plan worldwide. Modern curriculum development is proposed (i) Educational goals and objectives as the proposed Conceptual framework "Technology proficiency" model (ii) Instructional strategies 'Five Bs' (iii) Implementation 'Five Ms'.

International Briefs

International Briefs

147. Curriculum Matters: A comparison of the UK Oral and Maxillofacial Surgery (OMFS), UK Oral Surgery (OS) and Union Of European Medical Specialists OMFS European Training Requirements

The 2020 UK OMFS Curriculum held by the General Medical Council (GMC) represented a major change in the structure of UK OMFS training. This change happened across all the surgical specialty curricula which were modified to fit a similar structure and format. In 2022 the UK Dental Regulator the General Dental Council (GDC) will publish new curricula for all dental specialties including the dental specialty of Oral Surgery.

The Concept of Dishonesty in British Medical Discipline

The Concept of Dishonesty in British Medical Discipline

The cost of dispensing errors in Iranian health system: a retrospective evaluation.

The problem of medication errors (MEs) has constantly been receiving considerable attention worldwide due to their health impact and costly consequences. MEs occur in all phases of prescription, preparation, administration, distribution and delivery to the patient; however, dispensing errors are more common in this study, we have attempted to identify various MEs that occurred by pharmacists and calculate their financial and physical harm costs. This was a 8-year retrospective study. This study evaluated the costs of MEs in the Iranian health system caused by dispensing mistakes from 2012 to 2019. We retrieved documents and reports from the Tehran Medical Council Archive. Then, we extracted dispensing error data from ME record forms and analyzed them using SPSS software. Cost of dispensing errors. Among 3000 available MEs documents, only 2.6% of cases were dispensing errors. Errors included dispensing of wrong medication (75.6%), delivering expired medicines (11.5%), wrong medication order (9%), wrong medicine compounding (2.6%) and wrong dose of medication (1.3%). The most common cause of dispensing errors was physicians' poor handwriting (23.1%). Legal reactions, due to MEs, occurred in a range of actions from written reprimand in the professional records to some months of deprivation from professional activities. The analysis of the MEs that lead to the legal prosecution in the Iranian Medical Council shows that most cases, according to the severity of harm, were dispensing wrong medicines which caused temporary patients harm.

The History of Medical Ethics in India

The History of Medical Ethics in India

Can a novel blended learning resource improve the simulation experience for international medical graduates working in the UK? A survey of kent surrey sussex trainees in anaesthesia

With the increasing number of International Medical Graduates (IMGs) hired by the UK National Healthcare Service (NHS), a unification of training becomes essential. One of the main obstacles facing IMGs is insufficient simulation-based training [1]. In 2021, 19,977 doctors were registered to the General Medical Council (GMC). 10,009 of them studied medicine outside the United Kingdom (UK) [2]. Blended learning offers the opportunity for engagement and interaction to facilitate learning experiences [3]. We created and distributed a survey to Anaesthetic trainees in the ‘Kent Surrey Sussex (KSS)’ Deanery. We received a total of 76 responses, 49 (64.5%) UK graduates (UKGs) and 27 (35.5%) international graduates. The survey was designed to ascertain their medical training, simulation experience, and their perception of that simulation experience. We also included additional questions aimed specifically at IMGs to demonstrate the best way they could be supported to acquaint themselves with the simulation process further. IMGs were less likely to have simulation training as an undergraduate (24% IMGs vs 96% UKGs), and 37% of IMGs had no simulation exposure before coming to the UK. IMGs were also exposed to fewer simulation sessions during their career when compared with UKGs. When asked how simulation can improve human factor variables, including teamworking, leadership, and managing stressful situations, both groups responded similarly. An exception was that IMGs were much more likely to ‘strongly agree’ that simulation improved their communication skills (41% vs 29%). IMGs were less likely to find the overall simulation experience ‘excellent’ (24% vs 51% in UKGs), suggesting more can be done to improve their perception of simulation ( Comparison of UKGs versus IMGs simulation experience. As well as asking about how simulation improved communication skills, responders were asked the impact simulation had in improving other core skills including teamwork, leadership, and managing stressful situations with both groups responding similarly. There is a clear discrepancy in simulation exposure and perception of simulation between IMGs and UKGs. We believe blended learning may be the solution to help bridge this gap. Our survey highlighted potential resources we can introduce, including introductory videos, additional learning materials, and attending simulation as an observer. We hope to incorporate some of these in the future within our Trust Simulation Department and, if successfully received, expand throughout the KSS deanery. 1. Martinerie L, Rasoaherinomenjanahary F, Ronot M, Fournier P, Dousset B, Tesnière A, Mariette C, Gaujoux S, Gronnier C. Health care simulation in developing countries and low-resource situations. J Contin Educ Health Prof. 2018;38(3):205–212 2. Campbell D. NHS hiring more doctors from outside UK and EEA than inside for first time. The Guardian. 8 June 2022. 3. Singh H. Building effective blended learning programs. Educational Technology. 2003; 43:51–54

Preparing final year medical students for their transition to foundation year 1 using simulation

The transition from medical student to Foundation Year 1 (FY1) doctor represents a vital stage in the development of a newly qualified doctor. It is well established that medical students struggle with this transition [1]. There is evidence that simulation-based education (SBE) improves competence and confidence [2]. At our Trust, medical students undergo a Transition to Foundation Year 1 (TTF1) placement to prepare them for their upcoming roles. This study’s aim was to improve the confidence of final year medical students beginning their FY1 jobs in August 2022 by introducing them to common FY1 situations like prioritising tasks, handing over, being part of the on-call team, and practising clinical skills to improve patient safety as per the General Medical Council (GMC) outcomes for graduates [3]. We designed and implemented a simulation-based training day during their TTF1 placement. We collected feedback from a focus group of nine final year medical students regarding what would help best prepare them. We mapped these against their medical school’s curriculum and the GMC’s framework [3]. They reported they were inadequately prepared for FY1 and all agreed to have a training day covering different domains to increase their confidence. We designed a TTF1 training day that included lecture-based teaching on how to survive FY1, three scenarios based on common FY1 situations and a teaching session on ultrasound guided cannulation. The training day was delivered to five cohorts (29 medical students) during their TTF1 placements in 2022. During this training day, medical students completed a pre- and post-programme questionnaire which measured self-reported changes in confidence levels via a 5-point Likert scale across domains: verifying deaths, prioritising tasks, cannulation, handing over, and being part of the on-call team. The questionnaire also explored their expectations of the day and what they had learnt from the day. This was analysed using the framework analysis. Quantitative results revealed: increased preparedness for their FY1 role (+24%; <0.001) and being part of the on-call team (+58.7%; p<0.001), increased confidence in prioritising tasks (+28.6%; <0.001), verifying deaths (+131.5%: <0.001), and cannulation (+50%; <0.001). Analysis of qualitative results revealed common themes of improved confidence in ultrasound guided cannulation, increased knowledge-base, clearer understanding of handling common FY1 situations, and 100% of participants agreed that this training day was useful. The implementation of a TTF1 training day proved to increase the students’ confidence and levels of preparedness for their upcoming jobs. 1. Cameron A, Millar J, Szmidt N, Hanlon K, Cleland J. Can new doctors be prepared for practice? A review. Clin Teach. 2014;11:188–192. 2. Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock. 2010;3(4):348. 3. General Medical Council. Outcomes for Graduates 2018. 2018.

Clinical Skills Day: A Novel Approach to Enhancing Procedural Skills Teaching for Foundation Year One Doctors.

Background Completion of the Foundation Year One (FY1) doctor training is a requirement for full General Medical Council registration in the United Kingdom. Training during this year is mapped to a curriculum with one of the key elements being safe procedural skills. The objective of this project was to improve the teaching of procedural skills through the means of a Clinical Skills Day (CSD) and to quantify any improvement. Materials and methods A one-group pretest-posttest design was conducted on 32 doctors who completed a confidence inventory before and after four core procedural stations: suturing, urethral catheterisation (both male and female), lumbar puncture, and bimanual and speculum examinations. The intervention of simulated procedural skills occurred under the supervision of senior clinicians, with FY1 doctors receiving teaching and practising the four skills. The primary outcome was the impact of a CSD on trainees' confidence in performing certain skills. Pre- and post-CSD trainees' confidence levels were collected via an online-focused questionnaire and descriptive statistics, paired t-test, and one-way analysis of variance (ANOVA) with post-hoc Bonferroni comparisons were undertaken for statistical analysis. Results The difference in the mean scores of confidence post-intervention was significant in all four procedural stations with or without supervision (p <0.0001). Conclusions The use of CSDs impacted positively on the FY1 doctors' confidence in performing certain skills. Wider implementation of this promising approach for Foundation Doctors is recommended.

Discussing spiritual health in primary care and the HOPE tool—A mixed methods survey of GP views

In the UK, the General Medical Council (GMC) and Royal College of General Practitioners (RCGP) require doctors to consider spiritual health in their consultations. There are documented barriers to discussion of spiritual health, and suggested tools to help overcome them. To investigate how comfortable general practitioners (GPs) feel about discussing spiritual health in the consultation, and whether a structured tool (the HOPE tool) would be helpful. A mixed-methods online survey completed by GPs in England. A mixed methods online survey of practicing GPs in England asked about current comfort with the topic of spiritual health and use of spiritual history-taking tools. The acceptability of the HOPE tool was investigated using patient vignettes drawn from clinical practice. 177 GPs responded. 88 (49.71%) reported that they were comfortable asking patients about spiritual health. GPs felt most comfortable raising the topic after a patient cue (mean difference between pre and post cue 26%). The HOPE tool was viewed as acceptable to use with patients by 65% of participants, although its limitations were acknowledged. Qualitative data showed concerns about regulator (the GMC) and peer disapproval were major barriers to discussions, especially in the case of discordance between patient and doctor background. Only half of GPs are comfortable discussing spiritual health. Dedicated training, using a structured approach, with regulatory approval, may help overcome barriers to GPs discussing spiritual health. Further research into the benefits, and risks, of discussion of spiritual health in the GP consultation is recommended.

A survey and critical analysis of the teaching of medical ethics in UK medical schools

This article surveys and analyses the reflections on medical ethics teaching by colleagues teaching in United Kingdom (UK) medical schools in the early 2020s. Participants were recruited mainly by using the worldwide web to identify 64 people from 41 UK medical schools who were thought to contribute to teaching medical ethics based on their internet profiles. Twenty-three people responded. The survey data reveals that many staff are happy with the provision of medical ethics teaching, but also that some are concerned about the quality of provision due to concerns with staff expertise and teaching time. In spite of the fact that the General Medical Council (GMC) and other organisations are perceived to have contributed to raising the profile of medical ethics, there is significant concern with how it is embedded within local UK medical curricula. Some participants contributed hardly or not at all to research in medical ethics, where one attributed this decline in research to the pandemic. Future work will need to address what can be done to improve the provision of medical ethics teaching to address some of these findings and to survey and analyse how perceptions might have changed in light of recent challenges and developments.

Confidence, consent and chaperones for pubertal staging examinations: a national survey

ObjectiveGeneral Medical Council (GMC) guidance describes an intimate examination as one that may be embarrassing for the patient, for example, breast or genitalia examination. Documentation of consent and use of...

Physician associate prescribing: perspectives, practices and pathways

With the introduction of statutory regulation of physician associates (PAs) through the General Medical Council (GMC) expected in 2024, we anticipate a consultation on whether PAs will be given prescribing rights and how this will happen. In anticipation of this consultation, we surveyed the opinions of PAs and healthcare professionals (HCPs) who work with them regarding prescribing rights for PAs. We had a combined response of more than 500 and the survey results show that the vast majority of respondents across the two groups are in favour of prescribing rights for PAs. While both HCPs and PAs overall feel that PAs should have prescribing rights, PAs prefer generalised rights while HCPs recommend specialist rights only. To ensure safe prescribing, we advocate for a safety assessment followed by a period of supervision in their specialty before prescribing rights are given: our data show that confidence, knowledge and safety increases with length of time in specialty. Prescribing rights for PAs will help them become more independent and valuable assets to the healthcare team, increasing efficiency and improving patient care.