NHS Education Scotland Research Articles

Creating a trauma informed intellectual disability workforce in Ayrshire and Arran

The Scottish Government has pledged to make the entire Scottish Workforce ‘trauma informed’ and is working in collaboration with NHS Education Scotland (NES) to support the implementation of this vision.With initial funding from NES and subsequent funding support from the Ayrshire & Arran Health and Social Care Partnerships’ Mental Health Innovation Fund, training has been developed and delivered at the trauma informed, trauma skilled and trauma enhanced practice levels (NES, 2019) across Ayrshire and Arran. The training has been created for staff working within services for people with intellectual disabilities.This article describes the process, feedback, challenges and succession plans for creating a trauma informed intellectual disability workforce across Ayrshire and Arran.Easy read summaryThe Scottish Government wants to make sure that everyone knows how to help people who have experienced psychological trauma.We know that people with an Intellectual Disability are more likely to have had traumatic experiences, such as physical, emotional or sexual abuse, during their lives.NHS Ayrshire and Arran have created and delivered training packages about how best to support people with an Intellectual Disability who have experienced trauma in their livesStaff in services for people with an Intellectual Disability have been given this training. Everyone who has attended has been very positive about it. We hope that more people working across Scotland will be trained in the same way as staff in Ayrshire.

A different state of mind: developing a mental health simulation programme for foundation doctors in Scotland

The new Foundation Curriculum 2021 for Doctors in Training (DiT) in the United Kingdom calls for an increased focus on developing mental health-related skills [1], bringing them into parity with physical health. The importance of developing the core clinical skills needed to work with patients who have mental illness is now well-recognised within medical education [2,3]. In collaboration with NHS Education Scotland (NES), we piloted a half-day programme of immersive high-fidelity simulation in Psychiatry for foundation year one (FY1) doctors working in NHS Lothian. Scenario design was by a core group consisting of simulation faculty and Foundation programme directors who were consultant psychiatrists and acted as content experts. The intended learning outcomes (ILOs) for these sessions were constructively aligned with key presentations set out in the revised Foundation Curriculum. The scenarios considered the limitations of practice for an FY1, particularly in regard to mental health law. The three immersive scenarios developed included management of an aggressive patient with delirium, challenging communication with relatives, and management of a depressed patient. Scenarios were based in general wards to maximise fidelity with FY1 experience. 18 sessions were run for FY1 doctors at the three main acute hospital sites in NHS Lothian to ensure equitable access. Participants completed a pre-session evaluation to determine their perceived ability to perform key skills, including assessment of a patient who has self-harmed, a patient with depressive symptoms, assessment of capacity and use of mental health legislation, use of verbal de-escalation, safe sedation, and how to take a collateral history. Assessments were made on a Likert scale and were repeated immediately following the session. We plan to repeat this questionnaire three months following the session. A total of 68 FY1 doctors attended the pilot sessions. When considering the percentage of participants who felt prepared or very prepared, substantial improvements were seen in all assessed domains following the session ( Percentage of candidates who reported feeling either prepared or very prepared to carry out they key skills included in the pilot sessions We have demonstrated that immersive simulation-based education can be used to improve knowledge and confidence in core aspects of psychiatry. With support from NES, we aim to offer this session to all FY1s in Scotland. 1. UK Foundation Programme (2021) UK Foundation Programme. 2. Piot MA, Dechartres A, Attoe C, Jollant F, Lemogne C, Layat Burn C, Rethans JJ, Michelet D, Cross S, Billon G, Guerrier G. Simulation in psychiatry for medical doctors: a systematic review and meta‐analysis. Medical Education. 2020;54(8):696–708. 3. Piot MA, Attoe C, Billon G, Cross S, Rethans JJ, Falissard B. Simulation training in psychiatry for medical education: a review. Frontiers in Psychiatry. 2021;12:658967.

Assessing the effect of Independent Prescribing for community optometrists and referral rates to Hospital Eye Services in Scotland.

Since 2010, General Ophthalmic Services (GOS) legislation and Independent Prescribing (IP) enable community optometrists to manage primary eye conditions. No studies have assessed the effect of IP. We wished to determine the distribution of IP optometrists and associated hospital referral rates across Scotland. In 2019, FOI requests (General Optical Council and NHS Education Scotland) identified all registered IP optometrists in Scotland and their registered postcodes. Data regarding community eye examinations and referrals to HES since 2010 were gathered via Information Services Division of NHS Scotland. As of March 2019, there were 278 IP optometrists in Scotland (278/1189;23.4%). Two hundred eighteen IP optometrists work in 293 practices across 11 of Scotland's 14 health boards. There was a strong correlation (r = +0.96) between population density and number of IP optometrists. Fifty-six percent of IP optometrists work in the two most deprived quintiles. Since IP's introduction, there has been a marked increase in anterior segment supplementary visits (+290%). Optometry referrals to GPs have reduced by 10.5%, but referrals to HES have increased by 118% (to 96,315). There was no correlation between quantity of IP optometrists and referral rates to HES (r = -0.06, 95% CI -0.64 to 0.56, p = 0.86). This is the first analysis of IP optometrists and associated referral rates in Scotland. Despite good geographical distribution and increased supplementary attendances, optometric referrals to HES have doubled and continue to rise. We propose a ratio of primary, supplementary, non-referral and referral rates to discern the true impact of IP versus non-IP community optometric behaviour.

Glaucoma management in primary care: barriers perceived by optometrists in Scotland.

Over the next 10years, the prevalence of glaucoma in the United Kingdom (UK) is predicted to rise by 22%,(The Way Forward: Glaucoma, The Royal College of Ophthalmologists, London, 2017) posing a considerable challenge to already overstretched hospital eye services. To help address this problem, services traditionally offered in hospital such as managing stable glaucoma patients, could be transferred to community optometrists. The aim of this study was to identify whether optometrists in Scotland have an interest in managing primary open angle glaucoma (POAG) in primary care and to assess perceived barriers. All optometrists on the NHS Education Scotland (NES) database were invited to participate in an online survey over a 7-week period. Optometrists were asked if they had an interest in being accredited to manage POAG in the community and a free text question was used to elicit perceived barriers. Responders with an interest in managing POAG were invited to take part in two further rounds of electronic surveying, using a modified Delphi approach, with the aim of reaching a consensus on perceived barriers. Two hundred and ninety-nine of 1566 optometrists (19%) responded to the survey. 229 (79%) expressed an interest in managing patients with POAG in primary care. The most commonly perceived barriers after two rounds of Delphi surveying were remuneration (29%), communication with secondary care (18%), perceived ophthalmology resistance (13%), training (11%) and capacity (10%). Multivariate regression revealed fewer years in practice and comfort using and interpreting results of pachymetry were associated with higher odds of interest in managing glaucoma in the community. Among survey responders, there was significant interest from community optometrists to being accredited to manage POAG in primary care. A collaborative approach between primary and secondary care will be required to address the concerns of community optometrists in any future expansion of their role in glaucoma management.

Sliding doors: Did drama-based inter-professional education improve the tensions round person-centred nursing and social care delivery for people with dementia: A mixed method exploratory study

This educational intervention takes place when the population of older people with dementia is increasing. Health and Social care professionals must work jointly in increasingly complex contexts. Negative attitudes towards older people are cited as a contributor to poor care delivery, including the use of dismissive and/or patronising language, failing to meet fundamental needs and afford choice. ‘Sliding Doors to Personal Futures’ is a joint, drama-based, educational initiative between NHS Education Scotland and the Scottish Social Services Council, delivered using interprofessional education (IPE) towards encouraging person-centred health and social care.This paper considers whether ‘Sliding Doors’ had an impact on social work and nursing students' attitudes to older people, person-centred care and interprofessional collaboration. Two groups of third year students were studied; one from nursing and one from social work. A mixed methods approach was taken and attitudes and attitudinal shifts measured and discussed.Quantitative results demonstrated that social work students made positive attitudinal shifts in some questionnaire items and collectively the social work students were more person-centred than nursing students in their care approaches. The qualitative data however, drawn from focus groups, illuminated these results and highlighted the link between the ability for a professional to be person-centred and the conceptual view of risk within the particular profession. Risk acceptance, the theoretical position of social work, may facilitate person-centred care, whereas the perceived risk-averse nature of the nursing profession may inhibit it. Students' attempts to understand the quantitative results, without understanding the restrictions and parameters of each other's profession, led them to revert to stereotypes and negative views of each other as practitioners.The paper concludes that there is an important difference between nurses' and social workers' frames of reference. It is suggested that IPE in its current form will not impact positively on outcomes for older people, unless both professions can openly acknowledge the reality of their professional contexts and develop an understanding of each other's professional restrictions, opportunities and aspirations.

Progress in addressing FASD in Scotland

In Scotland, despite high levels of alcohol use by women, public awareness and professional knowledge of the risks of drinking while pregnant are low and there has been very little research into foetal alcohol spectrum disorders (FASD) and their effects. Recently, however, the Scottish Government has shown leadership with the commissioning of an FASD e-learning resource from NHS Education Scotland, the development of a toolkit for FASD Awareness Day and the planned institution of two two-day intensive training courses for health and social care professionals in the recognition, assessment, diagnosis and support of children affected by foetal alcohol harm. This article charts some of these developments.

Real-time Medical Visualization of Human Head and Neck Anatomy and its Applications for Dental Training and Simulation

The Digital Design Studio and NHS Education Scotland have developed ultra-high definition real-time interactive 3D anatomy of the head and neck for dental teaching, training and simulation purposes. In this paper we present an established workflow using state-of-the-art 3D laser scanning technology and software for design and construction of medical data and describe the workflow practices and protocols in the head and neck anatomy project. Anatomical data was acquired through topographical laser scanning of a destructively dissected cadaver. Each stage of model development was clinically validated to produce a normalised human dataset which was transformed into a real-time environment capable of large-scale 3D stereoscopic display in medical teaching labs across Scotland, whilst also supporting single users with laptops and PC. Specific functionality supported within the 3D Head and Neck viewer includes anatomical labelling, guillotine tools and selection tools to expand specific local regions of anatomy. The software environment allows thorough and meaningful investigation to take place of all major and minor anatomical structures and systems whilst providing the user with the means to record sessions and individual scenes for learning and training purposes. The model and software have also been adapted to permit interactive haptic simulation of the injection of a local anaesthetic.

Action learning sets in a nursing and midwifery practice learning context: A realistic evaluation

Action learning sets (ALS) are used widely for organisational and workforce development, including in nursing (Anderson and Thorpe, 2004; Pounder, 2009; Young et al., 2010). In the United Kingdom, a multi-faceted educational Pilot programme for new nurses and midwives was implemented to accelerate their clinical practice and leadership development (NHS Education Scotland, 2010). Action Learning Sets were provided for peer support and personal development. The Realistic Evaluation study reported in this paper explored issues of context, mechanism and outcome (Pawson and Tilley, 1997) influencing the action learning experiences of: programme participants (recently qualified nurses and midwives, from different practice settings); and programme supporters. A range of data were collected via: online questionnaires from 66 participants and 29 supporters; three focus groups, each comprising between eight and 10 programme participants; and one focus group with three action learning facilitators. The qualitative data pertaining to the ALS are presented in this paper. Thematic data analysis of context, mechanism and outcome configurations, generated five themes: creating and sustaining a collective learning environment; challenging constructively; collective support; the role of feedback; and effectiveness of ALS. Study outcomes suggest nursing and midwifery action learning should (a) be facilitated positively to improve participants' experience; (b) be renamed to avoid learning methodology confusion; and (c) be outcome focused to evidence impact on practice.

Learning about Spiritual Care: It Matters!

Spiritual Care is everybody’s business (SEHD, 2002, SGHD, 2008), presenting many challenges as we go about our daily work; therefore education is important in helping us prepare to meet such challenges. A small e-learning unit (GLIDER™) aimed at all healthcare workers who have contact with patients and their families was developed in partnership with the University of Dundee and NHS Tayside, supported by NHS Greater Glasgow and Clyde, funded by NHS Education Scotland. Common themes of change were noted in participants including them becoming more focussed in their thinking, more aware of the needs of their colleagues and considerate to the place of faith as appropriate to the individual.The GLIDER™ is now a compulsory part of the undergraduate nursing programme at the University of Dundee whilst currently being considered for inclusion in both the medical and dental school undergraduate programmes as part of the university’s commitment to interprofessional learning.

A regulatory framework for Scottish healthcare workers

British Journal of Healthcare AssistantsVol. 6, No. 3 Health MattersA regulatory framework for Scottish healthcare workersDebbie Donald, David ForbesDebbie DonaldSearch for more papers by this author, David ForbesSearch for more papers by this authorDebbie Donald; David ForbesPublished Online:16 Aug 2013https://doi.org/10.12968/bjha.2012.6.3.144AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References NHS Education Scotland (2010) A Guide to Healthcare Support Worker Education and Role Development.www.nes.scot.nhs.uk/media/350213/hcsw_report_final.pdf (accessed 28 February 2012) Google ScholarNHS Quality Improvement Scotland (2008) Journey to improvement: Piloting a model of regulation for healthcare support workers regulation in Scotland. Draft Management Report. NHS QIS, Edinburgh Google ScholarScottish Government (2009a)Code of practice for employers of healthcare support workers in Scotland.www.scotland.gov.uk/Resource/Doc/288858/0088361.pdf (accessed 28 February 2012) Google ScholarScottish Government (2009b) Code of conduct for healthcare support workers.www.scotland.gov.uk/Resource/Doc/288853/0088360.pdf (accessed 28 February 2012) Google ScholarScottish Government (2010) Chief Executive Letter (CEL) 23 Healthcare support workers— Mandatory standards and code of conduct for healthcare support workers and mandatory code of practice for employers of healthcare support workers.www.sehd.scot.nhs.uk/mels/CEL2010_23.pdf (accessed 28 February 2012) Google ScholarScottish Government Social Research (2009) Healthcare support workers in Scotland: Evaluation of a national pilot of standards and listing in three NHS boards. www.scotland.gov.uk/Resource/Doc/274092/0081988.pdf (accessed 28 February 2012) Google Scholar FiguresReferencesRelatedDetailsCited byDeveloping the role of the AP in NHS Scotland16 August 2013 | British Journal of Healthcare Assistants, Vol. 6, No. 8 1 March 2012Volume 6Issue 3ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 16 August 2013 Published in print 1 March 2012 Information© MA Healthcare LimitedPDF download

Formative assessment of GP trainees’ clinical skills

Clinical skill assessment (CSA) has been an integral part of the Royal College of General Practitioners' membership examination (MRCGP) since 2008. It is an expensive, high-stakes examination with first time pass rates ranging from 76.4 to 81.3. In this paper we describe the South East Scotland Deanery, NHS Education Scotland, pilot of a formative clinical skills assessment (fCSA) using the principles of formative assessment and OSCE. The purpose of the study was to assess the acceptability of the fCSA and to examine whether trainees, identified during the fCSA as 'at risk of failing the MRCGP CSA exam', are more likely to fail the MRCGP CSA exam later on in the year. Trainees were assessed in four clinical skills stations under exam conditions. After each station they were given verbal feedback and subsequently both trainee and their trainer received written feedback. We assessed the value of the exercise through written feedback from trainees and trainers. Each trainee's performance in fCSA was triangulated with trainer assessment to identify 'flagged trainees'. We compared flagged and non-flagged trainees' performance in MRCGP CSA. Both trainees and trainers highly rated the fCSA. Overall 97% of non-flagged trainees have passed the RCGP CSA exam by May of that year in comparison to 80% of flagged trainees who have passed the RCGP CSA (P = 0.005). Trainers and trainees rated the fCSA as excellent and useful. We were able to demonstrate that the fCSA can be used to identify those trainees likely to fail the RCGP CSA. Contrary to reservations about the potential to demoralise trainees, the fCSA was viewed as a useful and a positive experience by both trainees and trainers. In addition, we suggest that feedback from fCSA was useful in triggering appropriate educational interventions. Early intervention with trainees who are predicted to fail the CSA has the potential to reduce deaneries overall fail rate. Preventing one trainee failure could save over £30 000.

Flying Start NHS™: easing the transition from student to registered health professional

To evaluate the impact and effectiveness of Flying Start NHS™ on the confidence, competence and career development of newly qualified practitioners. The first year of practice as a registered nurse, midwife, or allied health professional is recognised as challenging. This paper presents the findings of a two-year evaluation of Flying Start NHS™, a web-based programme developed by NHS Education Scotland to support newly qualified health professionals during the transition from student to qualified practitioner. Descriptive design with one to one and focus group interviews, plus a survey. The evaluation employed a multi-method approach including telephone interviews with Flying Start NHS™ leads/coordinators (n=21) and mentors (n=22) and focus groups with newly qualified practitioners (n=95). An online survey was completed by 547 newly qualified practitioners. A majority of newly qualified practitioners reported that Flying Start NHS™ had been useful in terms of clinical skills development and confidence. Those who were able to take protected time were more likely to complete the learning units and report that the support they received was good. Both newly qualified practitioners and mentors reported a lack of time. Newly qualified practitioners who took up posts in the community expressed greater satisfaction with the support received. NHS Boards should ensure that there is an ethos of support at all levels, as well as an understanding of the purpose of Flying Start NHS™ and what newly qualified practitioners require to do to complete it. The expectation that newly qualified practitioners will enrol on Flying Start NHS™ should be accompanied by an expectation that they will complete the programme in their first year, coupled with support to enable them to do so. Undertaking Flying Start NHS™ in the first year of employment increases clinical skills development and confidence. Mentors require training and time to enable them to provide support.

Evolving Perioperative Roles: Nicety or Necessity?

In recent years we have experienced considerable interest in new roles but since the demise of the National Practitioner Programme (England) in 2007, much has gone quiet. NHS Education Scotland (NES) continues with the Physician Assistant pilots and there is evidence of developments at individual SHA level, but nothing like the activity we observed through 2005-2007. However the commitment to secure significant service transformation is predicated on the future workforce engaging differently and in new ways.

Improving antimicrobial prescribing through knowledge and skills

Sir, In their recent qualitative study of factors influencing antimicrobial prescribing by non-consultant hospital doctors De Souza et al. found that undergraduate education, hospital guidelines and concerns about emerging resistance were minor influences on prescribing practice. Prescribing was more influenced by instruction passed down through a hierarchical system and subsequently on personal experience. This will lead to poor adherence to local guidelines and inevitably poor prescribing. Poor prescribing by new UK graduates, often due to a lack of an integrated scientific and clinical knowledge base, and the lack of practical prescribing instruction for undergraduates are wellrecognized problems. Clinician education has been found to be the most effective workplace intervention on improving antibiotic selection in a recent systematic review. One apparent barrier to appropriate antimicrobial prescribing is the lack of awareness among senior and training grade clinicians of the local and national resources available to support decision making, including local hospital protocols. Prescribing guidelines appear to be ineffective unless accompanied by educational or financial incentives. Whilst in NHS hospitals it is unlikely that we will be able to meaningfully financially reward individuals or even clinical groups it would seem that optimizing prescribing through improving knowledge and clinical skills may be a more pragmatic approach. At Ninewells Hospital and Medical School in Dundee a concerted and multi-disciplinary effort has been made over recent years to promote and improve prudent antimicrobial prescribing through greater engagement in the undergraduate medical school curriculum and continuing postgraduate educational meetings. Pro-active promotion of local good practice guidance through a variety of educational activities is one such example. Audits of knowledge and behaviour regarding sepsis and antimicrobial therapy among training-grade doctors showed promising improvements between 1999 and 2003 as a result of these initiatives. However, these evaluations and those of others have highlighted the need for clinically focussed and sustainable national learning tools that address the technical and non-technical knowledge and skills of the antimicrobial prescriber. An outcomes based web-based program (Appropriate Antimicrobial Prescribing for Tomorrows Doctors: APT) for teaching and reflective learning of antimicrobial prescribing has recently been developed by infection specialists and medical educationalists and has been adopted by medical schools throughout the UK. The primary resource for the APT project is an interactive website (http://www.dundee.ac.uk/ facmedden/APT/index.htm) with access to clinical worked examples, prescribing exercises, self-assessment tools and a reflective learning logbook. Although the emphasis is on prudent prescribing of antibiotic therapy the principles learned through APT can be applied to all areas of prescribing. In our medical school this forms an integral part of clinical infection teaching in the fourth year that also includes recognition, diagnosis and management of common infections, infection control and health protection aspects of infection. This teaching is delivered by infectious disease physicians, microbiologists, infection control nurses, pharmacists and public health clinicians. Evaluation of this program through student and staff feedback has revealed very positive results and we are presently evaluating student knowledge through a series of short exams at the beginning and end of each attachment, and at the end of the year. In line with national Scottish Recommendations for improving antimicrobial prescribing practice in Scotland the APT work has been further adapted for providing mandatory online e-based training and assessment for foundation doctors in Scotland through the Doctors Online Training System (DOTS) developed by NHS Education Scotland (NES) (https://www. nhsdots.org/nhsdots/dotsx/login.asp). This site is password protected and linked to the NES Healthcare Acquired Infection portal (http://www.nes.scot.nhs.uk/hai/). At any given time there are more than 1600 foundation doctors in Scotland who will have to undertake this mandatory exercise and show evidence of satisfactory completion of this module. This program, through clinical vignettes, revises, evaluates and then reinforces the principles and practices taught at undergraduate level for foundation doctors. An extension and probable further adaptation of this program is proposed for more senior training and non-training grade doctors and ultimately non-medical prescribers. Any persons outside Scotland interested in this work should please contact dilip.nathwani@nhs.net. Ongoing evaluation of this program will inform its further development and impact.