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Single best answer questions as a teaching tool in medical education : an international mixed-method comparative evaluationIntroduction Single Best Answer questions are an established assessment format in medical education, however, their use as a teaching tool is underexplored in the literature. We aimed to assess the effectiveness and impact of implementing Single Best Answer (SBA) questions into lecture teaching, compared to standard lectures. Methods This evaluation utilised a mixed-method retrospective approach, combining quantitative and qualitative analysis of routine teaching feedback. Over a 2-year period, 10 standard teaching sessions were initially conducted, followed by the development of 43 SBA teaching sessions aimed at improving teaching delivery. Students completed anonymised questionnaires voluntarily after each teaching session (n=3,814 in teaching with SBAs; n=868 in teaching without SBAs). Quantitative data was compared using Welch's t-test. Statistical analysis was completed using the SPSS version 26.0 software (IBM Corp., Armonk, USA), with p < 0.05 considered statistically significant. Results The mean perceived confidence increase in topics before and after teaching was significantly higher with the SBA lecture compared to the standard lecture teaching group (1.32 ± 0.14, 1.07 ± 0.12 respectively; p < 0.001). Engagement levels were significantly higher in the SBA lecture compared to the standard lecture group (4.55 ± 0.12, 4.21 ± 0.15 respectively; p < 0.001). Qualitative data supported these results. Conclusion Single Best Answer question use significantly improved student perceived learning outcomes and engagement, indicating its higher efficacy as a teaching tool in our educational programme. This evaluation highlights the potential use of SBA questions to enhance learning in medical education, further studies and testing methods are required to support its wider generalisability.
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Adapting to change: The evolution of the specialty training level 3 (ST3) trauma and orthopaedics selection process before, during, and after the COVID-19 pandemic.The selection process for Specialty Training Level 3 (ST3) in trauma and orthopaedics is a pivotal yet challenging step for aspiring orthopaedic surgeons. Drawing on personal experience and research, this paper aims to provide a comprehensive analysis of the ST3 selection process, outlining the key stages, including application submission, portfolio evaluation, and interview performance. With recent changes, such as evolving self-assessment scoring criteria and the introduction of a communication station in 2024, candidates face an increasingly dynamic and competitive landscape. This review study explores the challenges faced by both candidates and authorities, including adapting to sudden changes, maintaining fairness, and ensuring robust assessments. By offering insights into the evolution of the selection process and practical advice for preparation, this paper seeks to guide future candidates in navigating the complexities of this rigorous process and contribute to a greater understanding of what is required to succeed in this highly sought-after specialty.
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Breaking good news: a Foundation year doctor's perspectiveNo abstract available
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Back to the future of academic anaesthesia: publication outputs of UK anaesthetistsNo abstract available
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Innovative approaches to continuing medical educationBackground: Continuing medical education (CME) is vital for healthcare professionals to maintain clinical competence and keep pace with the rapidly evolving medical landscape. Traditional CME models often fall short of meeting the dynamic needs of modern healthcare professionals. Objective: This study explores innovative CME methods, including microlearning, Just-in-Time Training (JITT), and digital platforms, to assess their effectiveness and identify potential barriers to adoption. Methods: A mixed-methods approach was employed, integrating a systematic literature review with quantitative surveys of 300 healthcare professionals and qualitative interviews with 50 CME administrators. The study was conducted at Birmingham Heartlands Hospital. Statistical analyses were performed on the quantitative data, while thematic analysis was applied to qualitative responses to identify key themes and insights. Results: Microlearning was regularly utilized by 234 participants (78%), with 204 participants (68%) indicating it as their preferred learning method due to its flexibility and efficiency. JITT was particularly valued in critical care settings, with 135 participants (45%) employing it and 210 participants (70%) expressing high satisfaction. Digital platforms were accessed by 276 participants (92%), with 264 participants (88%) expressing satisfaction with their content diversity and ease of access. Major barriers identified included digital literacy challenges, reported by 156 participants (52%), and technological access limitations, reported by 144 participants (48%). Conclusion: Innovative CME approaches like microlearning, JITT, and digital platforms show great promise in aligning with the current needs of healthcare professionals. Addressing barriers such as digital literacy and technological infrastructure is essential to ensure widespread adoption and maximize their impact on healthcare outcomes.
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Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) - a mixed methods evaluation.Aim: To evaluate healthcare professional (HCP) students clinical learning experiences' whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence. Background: The English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions. Design: A mixed methods convergent design. Methods: An online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method. Results: Undergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations. Conclusions: The SLCLE allocation enhanced students' confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students' professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students.
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Maxillofacial education in the time of COVID-19: the West Midlands experience.COVID-19 has accelerated a reliance on virtual technology for the delivery of postgraduate surgical education. We sought to develop a regional teaching programme with robust quality assurance. Webinars were delivered on a weekly basis by subspecialty experts using Zoom™ augmented with interactive polling software. Trainee feedback comprised Likert item rating on content and delivery, free text comments and self-assessed confidence levels using visual analogue scale (VAS) scores. A focus group was also convened and transcripts assessed with grounded theory analysis. Likert items revealed 442 (93.2%) positive responses regarding content and 642 (96.7%) positive responses regarding trainer delivery. There were statistically significant improvements in VAS scores across all programme content. Key themes from the focus group analysis were the pragmatics of delivering online education, issues surrounding trainer interactivity in the virtual world, the identification of the FRCS as a driving factor and a desire for case-based content and pre-learning of information (the 'flipped classroom'). We are continuing to be reactive to trainee feedback in developing our online learning programme which will also include a regional Moodle-based virtual learning environment (VLE), the subject of future educational research in our region.
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Machine learning for health: algorithm auditing & quality control.Developers proposing new machine learning for health (ML4H) tools often pledge to match or even surpass the performance of existing tools, yet the reality is usually more complicated. Reliable deployment of ML4H to the real world is challenging as examples from diabetic retinopathy or Covid-19 screening show. We envision an integrated framework of algorithm auditing and quality control that provides a path towards the effective and reliable application of ML systems in healthcare. In this editorial, we give a summary of ongoing work towards that vision and announce a call for participation to the special issue Machine Learning for Health: Algorithm Auditing & Quality Control in this journal to advance the practice of ML4H auditing.
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Comorbidities and covid-19.No abstract available
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Cloud computing enabled big multi-omics data analytics.High-throughput experiments enable researchers to explore complex multifactorial diseases through large-scale analysis of omics data. Challenges for such high-dimensional data sets include storage, analyses, and sharing. Recent innovations in computational technologies and approaches, especially in cloud computing, offer a promising, low-cost, and highly flexible solution in the bioinformatics domain. Cloud computing is rapidly proving increasingly useful in molecular modeling, omics data analytics (eg, RNA sequencing, metabolomics, or proteomics data sets), and for the integration, analysis, and interpretation of phenotypic data. We review the adoption of advanced cloud-based and big data technologies for processing and analyzing omics data and provide insights into state-of-the-art cloud bioinformatics applications.
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Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review.Objectives: In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. Design: A scoping review was undertaken following JBI methodological guidance. Methods: 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. Results: 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. Conclusion: This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Alternative routes into clinical research: a guide for early career doctorsNo abstract available
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Developing a simulation-based learning model for acute medical education during COVID-19 pandemic with Simulation via Instant Messaging - Birmingham Advance (SIMBA).Simulation-based learning (SBL) is well-established in medical education and has gained popularity, particularly during the COVID-19 pandemic when in-person teaching is infeasible. SBL replicates real-life scenarios and provides a fully immersive yet safe learning environment to develop clinical competency. Simulation via Instant Messaging - Birmingham Advance (SIMBA) is an exemplar of SBL, which we previously showed to be effective in endocrinology and diabetes. Previous studies reported the efficacy of SBL in acute medicine. We studied SIMBA as a learning intervention for healthcare professionals interested in acute medicine and defined our aims using the Kirkpatrick model: (i) develop an SBL tool to improve case management; (ii) evaluate experiences and confidence before and after; and (iii) compare efficacy across training levels.Three sessions were conducted, each representing a PDSA cycle (Plan-Do-Study-Act), consisting of four cases and advertised to healthcare professionals at our hospital and social media. Moderators facilitated progression through 25 min simulations and adopted patient and clinical roles as appropriate. Consultants chaired discussion sessions using relevant guidelines. Presimulation and postsimulation questionnaires evaluated self-reported confidence, feedback and intended changes to clinical practice.Improvements were observed in self-reported confidence managing simulated cases across all sessions. Of participants, 93.3% found SIMBA applicable to clinical practice, while 89.3% and 88.0% felt SIMBA aided personal and professional development, respectively. Interestingly, 68.0% preferred SIMBA to traditional teaching methods. Following participant feedback, more challenging cases were included, and we extended the time for simulation and discussion. The transcripts were amended to facilitate more participant-moderator interaction representing clinical practice. In addition, we refined participant recruitment over the three sessions. In cycle 1, we advertised incentives: participation counted towards teaching requirements, certificates and feedback. To rectify the reduction in participants in cycle 2, we implemented new advertisement methods in cycle 3, including on-site posters, reminder emails and recruitment of the defence deanery cohort.
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The clinical teaching fellow role: exploring expectations and experiences.Background: Many UK junior doctors are now taking a year out of the traditional training pathway, usually before specialty training, and some choose to work as a clinical teaching fellow (CTF). CTFs primarily have responsibility for delivering hospital-based teaching to undergraduate medical students. Only a very small amount of literature is available regarding CTF posts, none of which has explored why doctors choose to undertake the role and their expectations of the job. This study aimed to explore the expectations and experiences of CTFs employed at NHS hospital Trusts in the West Midlands. Methods: CTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 took part in a survey and a focus group. Results: Twenty-eight CTFs participated in the survey and ten participated in the focus group. In the survey, participants reported choosing a CTF role due to an interest in teaching, wanting time out of training, and being unsure of which specialty to choose. Expectations for the year in post were directly related to reasons for choosing the role with participants expecting to develop teaching skills, and have a break from usual clinical work and rotations. The focus group identified five main themes relating to experiences starting their job, time pressures and challenges faced in post, how CTF jobs differed between Trusts, and future career plans. Broadly, participants reported enjoying their year in a post at a mid-year point but identified particular challenges such as difficulties in starting the role and facing time pressures in their day-to-day work. Conclusion: This study has provided a valuable insight into the CTF role and why doctors choose a CTF post and some of the challenges experienced, adding to the sparse amount of literature. Understanding post holders' experiences may contribute to optimisation of the role. Those employing CTFs should consider ensuring a formal handover process is in place between outgoing and incoming CTFs, having a lead person at their Trust responsible for evaluating changes suggested by CTFs, and the balance of contractual duties and personal development time. Keywords: Teaching; Teaching fellows; Undergraduate medical education; Workforce.
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A novel generative adversarial networks modelling for the class imbalance problem in high dimensional omics dataClass imbalance remains a large problem in high-throughput omics analyses, causing bias towards the over-represented class when training machine learning-based classifiers. Oversampling is a common method used to balance classes, allowing for better generalization of the training data. More naive approaches can introduce other biases into the data, being especially sensitive to inaccuracies in the training data, a problem considering the characteristically noisy data obtained in healthcare. This is especially a problem with high-dimensional data. A generative adversarial network-based method is proposed for creating synthetic samples from small, high-dimensional data, to improve upon other more naive generative approaches. The method was compared with 'synthetic minority over-sampling technique' (SMOTE) and 'random oversampling' (RO). Generative methods were validated by training classifiers on the balanced data. Keywords: Class imbalance; GAN; Multiomics; Synthetic data.
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Construction and validation of a medical career readiness inventory.Background: Medical students' preparedness for clinical practice is well researched, yet little is known on the extent to which students are being prepared for a medical career. This paper reports the construction of a short medical inventory titled eXploring medical sTudents' caReer reAdiness (XTRA) to measure students' career readiness based on Super's theory of career maturity. Approach: We designed an instrument consisting of a series of 5-point Likert-scale to identify participants competencies regarding career exploration and planning during their undergraduate studies. The instrument was completed by 348 medical students from 41 universities in the United Kingdom. We examined the validity and reliability of the instrument through Exploratory Factor Analysis, Cronbach's coefficient α and Pearson correlation. Evaluation: Exploratory Factor Analysis revealed that 16 of the 20-items survey were aligned with the exploration stage of Super's theory: Crystallisation (Career goals), Specification (Career pathways) and Implementation (Career accomplishments). The four items that formed two separate statistical factors were specific to a current medical career in the UK. Internal reliability for Super's factor subscales were acceptable (α = 0.71 to α = 0.81). A significant positive relationship was found between students' overall rating of career readiness and the three factors, indicating construct validity. Implications: The XTRA Inventory is a short instrument with construct and content validity specifically designed to measure career readiness of medical students. Further work on its psychometric properties will help establish this inventory to be used as a guidance and career counselling tool by medical educators and educational institutions in developing career development programmes.
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Sustained clinical knowledge improvements from simulation experiences with Simulation via Instant Messaging-Birmingham Advance.Background: Simulation via Instant Messaging-Birmingham Advance (SIMBA) delivers simulation-based learning through WhatsApp and Zoom, helping to sustain continuing medical education (CME) for postgraduate healthcare professionals otherwise disrupted by the coronavirus (COVID-19) pandemic. This study aimed to assess whether SIMBA helped to improve clinical knowledge and if this improvement in knowledge was sustained over time. Methods: Two SIMBA sessions-thyroid and pituitary-were conducted in July-August 2020. Each session included simulation of various real-life cases and interactive discussion. Participants' self-reported confidence, acceptance, and knowledge were measured using surveys and multiple-choice questions pre- and post-simulation and in a 6- to 12-week follow-up period. The evaluation surveys were designed using Moore's 7 Levels of CME Outcomes Framework. Results: A total of 116 participants were included in the analysis. Significant improvement was observed in participants' self-reported confidence in approach to simulated cases (thyroid, n = 37, P < .0001; pituitary, n = 79, P < .0001). Significant improvement in clinical knowledge was observed following simulation (thyroid, n = 37, P < .0001; pituitary, n = 79, P < .0001). For both sessions, retention of confidence and knowledge was seen at 6-12 weeks' follow-up. Conclusions: SIMBA increased participants' clinical knowledge on simulated cases and this improvement was retained up to 6-12 weeks after the session. Further studies are required to explore long-term retention and whether it translates to improved real-world clinical practice.