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Background: The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS. Methods: This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change. Results: A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care. Conclusion: Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education. [ABSTRACT FROM AUTHOR]

Background: Development of diagnostic reasoning (DR) is fundamental to medical students' training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR. Methods: Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students' DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years. Results: The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students' DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct. Conclusions: Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners' understanding of and approach to assessing DR. [ABSTRACT FROM AUTHOR]

Background: Development of diagnostic reasoning (DR) is fundamental to medical students' training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR. Methods: Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students' DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years. Results: The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students' DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct. Conclusions: Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners' understanding of and approach to assessing DR. [ABSTRACT FROM AUTHOR]