UK Medical Schools Research Articles

Bridging the gap: Understanding the barriers and facilitators to performance for Black, Asian and Minority Ethnic medical students in the United Kingdom.

Differential attainment is a well-known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK. Using a sequential explanatory mixed-methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020-2021. Participants self-identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes. Three hundred sixty-two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys. Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students.

Evaluating the publication practices of medical students: A mixed-methods study

Purpose Engagement in research and publication helps medical students develop the skills to improve healthcare through evidence-based medicine. The qualitative evidence-base for the medical student experience of publishing is limited. This study aims to explore medical students’ publication practices and understand their experiences of research and publication. Methods The study is based on a mixed-methods convergent design. A survey questionnaire was distributed to medical students in UK medical schools by social media and email communication. We recruited volunteer participants through the survey and interviewed a sample whilst the survey was open. We purposively selected the sample to ensure representation from research-intensive and other universities. Results Survey results indicated that 21.3% (27/127) of respondents had a publication. The most common publication type was a conference abstract. The main motivation to publish was career progression and the main barriers were lack of opportunity or support to submit an article. There was no significant association between attending a research-intensive university and submitting an article. The interviews revealed that contributing to academic advancement was also a motivation to publish. Participants expressed receiving differing levels of support from supervisors and their institutions. Conclusions Data from the interviews suggested that the most commonly perceived barriers identified in the survey (lack of opportunity and support to conduct and publish research) may vary in prevalence between different medical schools. Further research is required to explore how different types of support offered by medical schools affect student engagement in publishing research.

Automated Item Generation: impact of item variants on performance and standard setting

BackgroundAutomated Item Generation (AIG) uses computer software to create multiple items from a single question model. There is currently a lack of data looking at whether item variants to a single question result in differences in student performance or human-derived standard setting. The purpose of this study was to use 50 Multiple Choice Questions (MCQs) as models to create four distinct tests which would be standard set and given to final year UK medical students, and then to compare the performance and standard setting data for each.MethodsPre-existing questions from the UK Medical Schools Council (MSC) Assessment Alliance item bank, created using traditional item writing techniques, were used to generate four ‘isomorphic’ 50-item MCQ tests using AIG software. Isomorphic questions use the same question template with minor alterations to test the same learning outcome. All UK medical schools were invited to deliver one of the four papers as an online formative assessment for their final year students. Each test was standard set using a modified Angoff method. Thematic analysis was conducted for item variants with high and low levels of variance in facility (for student performance) and average scores (for standard setting).ResultsTwo thousand two hundred eighteen students from 12 UK medical schools participated, with each school using one of the four papers. The average facility of the four papers ranged from 0.55–0.61, and the cut score ranged from 0.58–0.61. Twenty item models had a facility difference > 0.15 and 10 item models had a difference in standard setting of > 0.1. Variation in parameters that could alter clinical reasoning strategies had the greatest impact on item facility.ConclusionsItem facility varied to a greater extent than the standard set. This difference may relate to variants causing greater disruption of clinical reasoning strategies in novice learners compared to experts, but is confounded by the possibility that the performance differences may be explained at school level and therefore warrants further study.

Is sexual misconduct training sufficient in the UK's medical schools: Results of a cross-sectional survey and opportunities for improvement.

Sexual misconduct adversely affects the mental and physical health of millions of people each year and has been declared a global pandemic. Incidence in both educational and clinical settings remains high. In the last 5 years, the NHS spent over £4 million settling sexual misconduct-related claims. Effective prevention requires training across all stages of career, beginning in clinical school. Here, we explore training in the UK's medical schools to identify provision and areas for improvement. Freedom of Information Act 2000 requests for data on training delivery and curricula content. 34 public UK universities offering medical education. not applicable. Provision and delivery of training, mode of delivery, theme, and continuation of training. All 34 universities responded. Twenty-two identified offering training. Seventeen made it compulsory. A review of curricula identified, however, only 18 did more just than mentioned sexual misconduct. Nine offered training more than once. Twelve did not offer training, of which three identified no plans to offer such training in the future. The most common delivery modes for training were workshops and lectures. The training was most often within the sexual health curriculum, disconnecting it from professionalism. There is no standardisation of sexual harassment training across the UK's public medical schools. Many future doctors will not have received relevant education when they assume posts in the NHS. Considering the magnitude of this issue and its critical connection to professionalism and collegiality, universities and professional bodies urgently should address this deficiency.

Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students’ longitudinal experiences in primary care

ObjectiveLongitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum...

513 Surgical Science Secrets - an Innovative Way to Supplement Undergraduate Surgical Education

Abstract Aim In recent years undergraduate medical curriculum has been focusing on general practice. Together with the impact of COVID-19 pandemic, time spent on surgical education has been significantly reduced. Hence, medical graduates feel stressful when start working in surgical rotations. Our team has designed a peer reviewed teaching derived from National Undergraduate Surgical Curriculum which aims to prepare medical graduates for their surgical jobs. Method Four fundamental series covering general, orthopaedics, head and neck and vascular surgery were delivered every fortnight online from April to October 2022. Audience was invited to rate from a Likert Scale 1-5 to assess their confidence levels before and after the sessions. Sign test is used to ascertain whether the change in confidence level is statistically significant. Mann-Whitney U test is used to compare inter-series difference. Results There were in total 744 participants from UK and overseas medical schools. The average confidence level before and after the teaching sessions were 3.23 and 4.19. The change was statistically significant in each series (p<0.05) Majority of the audience preferred case discussions and MCQ-based teachings which helped with their final exam preparation. There was no inter-series statistical difference between orthopaedics and head and neck series (p>0.05). However, other series had demonstrated differences due to inconsistent audience size. Conclusions Online peer-to-peer teaching is a new trend to medical education since COVID-19 pandemic. With high yield contents and practice questions, it can enhance participants’ confidence in making medical decisions. Future work should be conducted with a constructive aligned teaching to standardise undergraduate medical education.

1122 Improving Medical Students’ Confidence in the Theatre Environment and Surgical Scrubbing Technique Through Pre-Placement ‘Theatre Prep’ Teaching: A Quality Improvement Project

Abstract Aim As the GMC states, medical students should be proficient in surgically related procedural skills, including scrubbing up, to ensure patient safety is maintained. Although students and consultants report these skills as top learning objectives for surgical placements, research shows students feel unprepared going into theatres. Evidence suggests that preparatory teaching increases confidence and maximises learning opportunities. This project aimed to improve confidence and preparedness for theatre amongst students at a large UK Medical School through the delivery of ‘theatre prep’ teaching. Method A PDSA structure was utilised through multiple cycles from September to December 2022, using a baseline questionnaire to compare each cycle’s outcomes against a control group. Feedback from students and stakeholders informed lesson plan updates after each cycle. Content focussed on theatre etiquette and practical scrubbing up teaching. Results A Likert scale established self-reported students’ confidence, graded from 1 (very unconfident) to 5 (very confident). Data across all cycles showed that prior to attending theatre, students’ confidence in going into theatres, and scrubbing up, was low (average 2.14 and 1.66 respectively). Control group data showed that students’ reported confidence improved by an average of 1.52 and 1.48 respectively post-placement. Comparatively, following 'theatre prep' teaching, groups reported an increase in confidence of 2.13 and 2.53 for cycle one, and 2.2 and 2.67 for cycle two. Conclusions Medical students report low confidence before going into theatre, particularly regarding scrubbing up. Confidence in both domains was greatly improved by having a ‘theatre prep’ teaching session. We recommend all medical school curricula incorporate similar content.

How is transition to medical practice shaped by a novel transitional role? A mixed-methods study

ObjectivesThis study considered a novel ‘interim’ transitional role for new doctors (termed ‘FiY1’, interim Foundation Year 1), bridging medical school and Foundation Programme (FP). Research questions considered effects on doctors’...

Career intentions of medical students in the UK: a national, cross-sectional study (AIMS study)

ObjectiveTo determine current UK medical students’ career intentions after graduation and on completing the Foundation Programme (FP), and to ascertain the motivations behind these intentions.DesignCross-sectional, mixed-methods survey of UK medical...

Evaluation of learning and exposure in the undergraduate interventional radiology curriculum (ELIXIR)

To gauge current final year medical students' exposure to interventional radiology (IR)and assess their perceptions of IR as a prospective career option. An online questionnaire comprising of questions that gauge final-year medical students' understanding of and exposure to IR based on the recommendations set out by the British Society of Interventional Radiology (BSIR), was sent out to final-year students across 34 UK medical schools. Five hundred and ten responses were collected from 33 out of 34 eligible medical schools. Sixty-four per cent of respondents rated their own IR knowledge as inadequate. On average, only 50% of all subtopics proposed in the BSIR undergraduate curriculum was covered during medical school and 32.7% of respondents were not exposed to any fundamental IR principles and techniques recommended by the BSIR during medical school. Regarding careers, 2.7% of respondents reported a definite interest in pursuing a career in IR. Most respondents (89.8%) felt that there was insufficient undergraduate teaching on IR and that they lacked information to consider pursuing a career in IR (87.5%). Insufficient exposure and teaching on IR throughout medical schools have led to a lack of awareness and consideration of IR as a future career choice amongst UK medical students. The re-evaluation of IR teaching in the medical school curricula is needed. In the long-term, such recommendations could provide the much-needed solution to the workforce shortages seen in IR.

Cultural Attitudes towards General Practice within Medical Schools: Experiences of GP Curriculum Leaders

ABSTRACT Introduction UK undergraduate medical curricula are under pressure to become more community-focused and generalist in approach to equip all future doctors with generalist skills and increase recruitment to generalist specialities like general practice. However, the amount of general practice teaching in UK undergraduate curricula is static or falling. Undervaluing, in the form of general practice denigration and undermining, is increasingly recognised from a student perspective. However, little is known about the perspectives of academics working within medical schools. Aim To explore the cultural attitudes towards general practice within medical schools as experienced by general practice curriculum leaders. Methods A qualitative study using semi-structured interviews of eight general practice curriculum leaders in UK medical schools. Purposive sampling for diversity was used. Interviews were analysed using reflexive thematic analysis. Findings Seven themes were identified covering ‘a kaleidoscope of attitudes towards general practice’, ‘overt everyday denigration of general practice’, ‘a hidden curriculum of undervaluing general practice’, ‘valuing general practice: representation, recognition and respect’, ‘relating to others, relating to oneself’, ‘power, empowerment and vulnerability’, and ‘the pandemic as an opportunity’. Conclusions Cultural attitudes towards general practice were diverse: a spectrum varying from valuing general practice to overt denigration, with a ‘hidden curriculum’ of subtle undervaluing of general practice. Hierarchical, tense relationships between general practice and hospital were a recurring theme. Leadership was identified as important in setting the tone for cultural attitudes, as well as indicating general practice is valued when general practitioners are included within leadership. Recommendations include a shift in narrative from denigration to mutual speciality respect between all doctors.

Applying to medical school with undiagnosed dyslexia: a collaborative autoethnography.

Recent statistics found the prevalence of dyslexia in UK medical schools to be 7%, sitting below the national prevalence of 10%. The factors contributing to this discrepancy are currently unknown, but may result from an interplay of individual and systemic barriers to entering medicine. This collaborative, analytic autoethnography aimed to use the experiences of 'Meg', a fourth-year medical student who was diagnosed as dyslexic whilst at medical school, to explore how the lack of a diagnosis during the admissions process may have impacted her journey into medicine. The data were collected using reflective writing and an interview before conducting a thematic analysis. Our analysis resulted in the construction of two meta-themes, relating to the negative emotional impact of not having a diagnosis and feelings of inferiority. Seven themes were also constructed. Some explored how Meg's personal experience of undiagnosed dyslexia acted as a barrier to entering medicine. Others explored the impact of external factors, such as socio-economic background and the provision of support, on an individual's chance of successfully applying to medical school. Finally, we explored the inadvertent impact undiagnosed (and unrecognised) dyslexia had on Meg's life course, including how medicine-specific aptitude tests, such as the BMAT and UKCAT, may have contributed to this. These results provide a unique window into the culture of applying to medical school as an undiagnosed dyslexic person, whilst discussing the need for medical schools to consider how their admissions processes may inadvertently disadvantage undiagnosed dyslexic applicants.

How well do UK assistantships equip medical students for graduate practice? Think EPAs

The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.

A cross-sectional evaluation of the current state of wound healing education in the United Kingdom's undergraduate medical curriculum.

Between 2013 and 2018, there has been a 71% increase in the number of patients who have required wound care in the NHS and such large numbers has placed a significant burden on healthcare systems. However, there is currently no evidence as to whether medical students are equipped with the necessary skills to deal with an increasing number of wound care related issues that patients present with. A total of 323 medical students across 18 UK medical schools completed an anonymous questionnaire evaluating the wound education received at their medical school, encompassing the volume, content, format and efficacy of teaching. 68.4% (221/323) of respondents had received some form of wound education during their undergraduate studies. On average students received 2.25 h of structured, preclinical teaching and only 1 h of clinical based teaching in total. All students that received wound education reported undertaking teaching on the physiology of, and factors affecting wound healing, with only 32.2% (n = 104) of students receiving clinically based wound education There was very weak correlation and no significant association in student's ability to assess wounds (R2 = 0.190, p = 0.013), manage wounds (R2 = 0.060, p = 0.37), and prescribe wound care products (R2 = 0.093, p = 0.18) with their stage of training. Students strongly agreed that wound education is an important part of the undergraduate curriculum and post graduate practice, and do not feel their learning needs have been met. This is the first study to assess the provision of wound education in the United Kingdom, demonstrating a clear deficit in the provision of wound education compared to expectation of junior doctors. Wound education is largely overlooked in the medical curriculum, lacks a clinical focus and does not prepare junior doctors with the necessary clinical abilities to deal with wound related pathology. Expert opinion to direct changes to future curriculum and further evaluation of teaching methodology is required to address this deficit and ensure students have the necessary clinical skills to excel as newly graduated doctors.

Predictors of self-reported research productivity amongst medical students in the United Kingdom: a national cross-sectional survey

BackgroundThe number of academic clinicians in the UK is declining and there are demographic inequalities in the clinical-academic workforce. Increased research productivity by medical students is believed to reduce future attrition in the clinical-academic workforce. Thus, this study investigated the association between student demographics and research productivity amongst UK medical students.MethodsThis is a national multicentre cross-sectional study of UK medical students in the 2020/21 academic year. We appointed one student representative per medical school, and they disseminated a 42-item online questionnaire over nine weeks, through departmental emails and social media advertisements. The outcome measures were: (i) publications (yes/no) (ii) number of publications (iii) number of first-authored publications (iv) abstract presentation (yes/no). We utilised multiple logistic and zero-inflated Poisson regression analyses to test for associations between the outcome measures and predictor variables at a 5% significance level.ResultsThere are 41 medical schools in the UK. We received 1573 responses from 36 UK medical schools. We failed to recruit student representatives from three newly formed medical schools, whilst two medical schools prohibited us from sending the survey to their students. Women had lower odds of having a publication (OR: 0.53, 95% CI: 0.33–0.85) and on average had fewer first-author publications than men (IRR: 0.57, 95% CI: 0.37–0.89). Compared to white students, mixed-ethnicity students had greater odds of having a publication (OR: 3.06, 95% CI: 1.67–5.59), an abstract presentation (OR: 2.12, 95% CI: 1.37–3.26), and on average had a greater number of publications (IRR: 1.87, 95% CI: 1.02–3.43). On average, students who attended independent UK secondary schools had a higher rate of first-author publications compared to those that attended state secondary schools (IRR: 1.97, 95% CI: 1.23–3.15).ConclusionOur data suggest that there are gender, ethnic and socioeconomic inequalities in research productivity among UK medical students. To tackle this, and potentially improve diversity in clinical academia, we recommend that medical schools should facilitate targeted high quality research mentorship, funding and training, especially for under-represented-in-medicine students.

The experiences of autistic medical students: A phenomenological study.

Increasing recognition of autism is reflected in the growing awareness of autistic health care providers. Regulatory bodies including the UK General Medical Council and the UK Medical Schools Council have published guidance fostering inclusion. Whilst many autistic doctors and students are thriving, many may not disclose their diagnosis unless difficulties arise, which perpetuates stereotypes. No studies have explored the experiences of autistic medical students. We aimed to do this. This was an interpretive phenomenological study. Autistic medical students were recruited using Facebook announcements. Participants underwent audio-recorded, loosely structured interviews. Recordings were transcribed verbatim and underwent an interpretive phenomenological analysis. Five participated from five different UK medical schools. Constructed themes included: Autistic profiles and stereotypes-'I'm a lot better with patients than I am with my peers, with staff, which is hard for a lot of people to understand'; sensory processing and the learning environment-'noises really hurt my ears … It actually hurts'; me, myself and masking-'so, medicine's hard. But I'm also studying myself and I'm figuring myself out and that degree is harder'; the social world-'I always feel like I'm watching my back'; and navigating the system-'[they say] "but you're going to be a doctor one day, so you need to get used to it"'. Participants longed for understanding and support from their medical schools. They reported experiences of isolation, bullying and anxiety. Most felt themselves to be victims of the system, whereby they were expected to adapt themselves in order to appear non-autistic. When participants reported not coping due to being autistic, most were advised to 'take time out'. None were offered personalised adjustments to their learning environment. All reported strengths associated with being autistic. This supports the assertion that autistic people can be safe, effective and skilled doctors.

What next for student mental health?

When I became President of the UK Royal College of Psychiatrists, I rashly promised to visit every UK medical school to talk with students about mental health. In this article, I share my impressions after concluding this 'grand tour' and ponder the dangers of creating the false impression that universities are 'toxic' for mental health.

Racism, Discrimination, and Harassment in Medical Schools in the UK: A Scoping Review

Background: Discrimination, racism, harassment, stereotyping, and bullying are a significant issue for medical students as they create a hostile environment with detrimental effect on student wellbeing and educational experience. Findings suggest that though prevalent, reporting of these experiences is rare and perceived as ineffective. Objectives: This scoping review aims to map the trends, types, and nature of discrimination, harassment, bullying, stereotyping, intimidation, and racism reports in undergraduate medical education in the UK since 2010 and to determine areas of focus for undertaking full systematic reviews in the future. Method: A search was conducted using the MEDLINE, AHMED, CINHL, and EMBASE electronic databases from 2010 up to February 2022 in English. Only primary research papers (e.g., cohort studies, cross-sectional studies, and case series) that report the words/phrases discrimination (including gender and racial), harassment (including verbal, sexual, academic, and physical), bullying, stereotype, intimidation, and racism within medical education in the UK after 2010, following the Equity Act 2010, were eligible for inclusion. Results: Five relevant articles relating to discrimination, harassment, bullying, stereotyping, intimidation, and racism in medical schools in the UK were included. Three themes were identified across these studies. Conclusions: The data suggest that there is a high prevalence rate of discrimination, harassment, and stereotyping being experienced by ethnic minority undergraduate medical students in the UK. There is underreporting due to perceived and structural barriers. The identified studies suggest that less progress has been made in these areas.

How do the post-graduation outcomes of students from gateway courses compare to those from standard entry medicine courses at the same medical schools?

BackgroundWidening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. ‘Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.’ This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities.MethodsData from 2007–13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school.ResultsFour thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%).ConclusionsGateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.

Inclusivity in transitioning to medical school.

Inclusivity in transitioning to medical school.