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Introduction: Deaths in care homes and "at home" are anticipated to account for a third of UK deaths by 2040. Currently, palliative and end of life care are not part of statutory training in care homes. Reflective practice is a tool that can facilitate practice‐based learning and support. Following a feasibly study to test "online" supportive conversations and reflection sessions (OSCaRS) to support care home staff in relation to death/dying during the first months of the COVID pandemic, a one‐year practice development follow‐up project was undertaken with the aim to create a team of NHS/specialist palliative care (SPC)‐based facilitators to lead and support OSCaRS provision in up to 50 care homes in one region in Scotland—the focus of this paper. Methods: Forty care home managers attended an on‐line session explaining the project, with a similar session held for 19 NHS/SPC‐based nurses external to care homes. Those interested in facilitating OSCaRS then attended three education sessions. Data collected: records of all activities; reflective notes on OSCaRS organised/delivered; a summary of each OSCaRS reflection/learning points; final interviews with NHS/SPC trainee facilitators. Results: A total of 19 NHS/SPC facilitators delivered one or more OSCaRS in 22 participating care homes. However, as of January 2022 only six trained facilitators remained active. Out of the 158 OSCaRS arranged, 96 took place with a total of 262 staff attending. There were three important aspects that emerged: the role, remit, and resources of NHS/SPC supporting OSCaRS; requirements within care homes for establishing OSCaRS; and, the practice‐based learning topics discussed at each OSCaRS. Conclusion: Attempts to establish a team of NHS/SPC facilitators to lead OSCaRS highlights that end of life care education in care homes does not clearly fall within the contractual remit of either group or risks being missed due to more pressing priorities. [ABSTRACT FROM AUTHOR]

Jo Hood details a new programme to create a change of scene. [ABSTRACT FROM AUTHOR]

Background: Since 2005 it has been a legal requirement in Scotland to have a suitably trained pharmacist verify SACT prescriptions. Published information for verification of SACT does not currently cover SACT prescribed within a clinical trial and the additional knowledge this requires. This poses the question of how pharmacists are deemed suitably trained to competently verify SACT prescribed within a clinical trial to ensure patient safety and service efficiency. Aim: To determine and gain consensus on the competency requirements for clinical pharmacist verification of SACT prescribed within a clinical trial. Method: A two stage process was adopted. Firstly, a Nominal Group Technique (NGT) was conducted with a multi-disciplinary expert panel (n = 7) from National Health Service (NHS) Lothian, part of the South East Scotland Cancer Network (SCAN). Secondly, a national survey was distributed to expert cancer care pharmacists with experience in clinical trial verification across NHS Scotland (n = 86). Results: Of the 28 competencies proposed, 100% achieved consensus and were deemed important by the expert panel during the NGT. From the national survey, 26 (92.9%) of the competencies achieved national agreement and were considered transferable across Scotland. The final national competencies were split into four categories: general trial background (n = 13); calculations, laboratory results and toxicity assessments (n = 7); administration details (n = 3); prescription and patient details (n = 3). Based on the themes identified during the NGT the final national competencies were further split into two suggested complexity levels; Level 1 (core) and Level 2 (advanced). Conclusion: The competency requirements for clinical pharmacist verification of SACT prescribed within a clinical trial were defined for national use across Scotland. The competencies were split into four categories and two complexity levels. Further work will be required to identify training requirements, develop a training programme to support these and to determine how these competencies should be assessed. In addition, further work could be undertaken to develop a United Kingdom wide competency framework based on the results of this study. [ABSTRACT FROM AUTHOR]

Background: Professional identity transitions, such as the transition to medical registrar, are challenging. How minoritised identities influence transitions during medical training requires further study. This study aimed to explore the factors influencing the transition to the medical registrar in Scotland to guide support during training., Methods: Interviews exploring this transition with internal medicine trainees were audio recorded, transcribed verbatim and double-coded using template analysis. We applied an initial coding template informed by multiple and multidimensional transition theory of individual, interpersonal, systemic and macro-level factors. Using a critical theory lens, a further template analysis specifically sought to understand how trainees' social identities interacted with the various levels., Findings: Nineteen IM trainees were interviewed between January 2021 and February 2022. Influential factors reflected a parallel process of competence (doing) and identity (being) development. The interaction of social identities, such as gender (being a woman) and country of origin (being an international medical graduate), occurred across levels. This can be conceptualised as a Rubik's cube with the interplay between doing and being from an individual to a macro level with trainees' social identities interacting at all levels., Conclusion: The transition to the medical registrar is multifaceted; with a challenging balance between support and independence in providing opportunities to perform (doing) whilst identity develops (being). Identity transitions involve multiple Rubik's-cube-like rotations between the facets of 'doing' and 'being,' until these align. Taking heed of influential factors and the interaction of minoritised social identities could guide a trainee-centred and smoother transition., (© 2023 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background: Assessment of capacity for treatment and discharge decisions is common in the general hospital. Liaison psychiatrists are often asked to support the treating medical or surgical team in difficult capacity assessments. However, empirical research on identification and resolution of difficult capacity cases is limited. Some studies have identified certain patient, decisional, and interpersonal factors which cause difficulty, but no study has explored how these issues are resolved in practice. Our study therefore aimed to describe how experienced liaison psychiatrists identify and resolve difficult capacity cases in a general hospital setting. Methods: We carried out semi-structured interviews with 26 liaison psychiatrists from England, Scotland, and New Zealand, on their most difficult capacity cases. Thematic analysis was used to examine types of difficulty and how these were resolved in practice. Summaries were prepared and example quotes extracted to illustrate phenomena described. Results: We identified four types of difficulty in capacity assessment, spanning both clinical and ethical domains: 1) Difficulty determining whether the decision is the patient's own or driven by illness, 2) Difficulty in applying ethical principles, 3) Difficulty in avoiding personal bias, and 4) Procedural difficulties. The liaison psychiatrists presented as selfreflective and aware of challenges and pitfalls in hard cases. We summarized their creative strategies to resolve difficulty in assessment. Conclusion: Practitioners approaching difficult capacity cases require both clinical skills, e.g., to uncover subtle illness impairing decision-making and to consider interpersonal dynamics, and ethical skills, e.g., to negotiate the role of values and risks in capacity assessment. Education and training programmes should incorporate both aspects and could include the resolution strategies identified in our study. Practitioners, supported by health and social care systems, should work to develop self-aware and reflective capacity assessment practice. [ABSTRACT FROM AUTHOR]

Introduction A new UK medical postgraduate curriculum prompted the creation of a novel national medical postgraduate 'boot camp'. An enhanced simulation-based mastery learning (SBML) methodology was created to deliver procedural skills teaching within this national boot camp. This study aimed to explore the impact of SBML in a UK medical boot camp. Methods One-hundred and two Scottish medical trainees attended a 3-day boot camp starting in August 2019. The novel enhanced SBML pathway entailed online pre-learning resources, deliberate practice, and simulation assessment and feedback. Data were gathered via pre- and post-boot camp questionnaires and assessment checklists. Results The vast majority of learners achieved the required standard of performance. Learners reported increased skill confidence levels, including skills not performed at the boot camp. Conclusion An enhanced SBML methodology in a boot camp model enabled streamlined, standardised procedural skill teaching to a national cohort of junior doctors. Training curricular competencies were achieved alongside increased skill confidence. [ABSTRACT FROM AUTHOR]

Longitudinal Integrated Clerkships (LIC) are known to provide several pedagogical advantages including transformational educational experiences. The study explored the learning experience of undergraduate medical students who undertook a rural LIC in a Scottish primary care setting. This paper presents an analysis of the transformative role of LIC placements using the Threshold Concept (TC) theory. This qualitative study gathered students' perceptions of their LIC experience longitudinally through written and audio diaries over a period of 1–2 months. The issues narrated in diaries were followed-up in individual semi-structured interviews. Transcripts were thematically analysed to identify key characteristics of TCs using a criterion-based approach. Data from 12 audio and nine written diaries, and five interviews led to identification of three inter-connected themes associated with the LIC year: professional identity formation, becoming an agentic learner and comfort with uncertainty. These appeared transformative in nature and resembled threshold concepts in their character and effect. An active and legitimate role in the healthcare team, longitudinality and transdisciplinary learning during LIC placements were contributary towards navigating these thresholds. The LIC exposure provided transformative learning experiences, and a stable environment that facilitated acquisition of specific TCs in the medical students' journey towards becoming a doctor. LIC affordances fostered a transformed view of self, which was more confident in dealing with uncertainty, comfortable in the emerging professional identity, and described having enhanced agentic capabilities. [ABSTRACT FROM AUTHOR]

Due to work load pressures in primary care, increasing efforts are being made internationally to implement pharmacists working alongside general practitioners. While there is wide interest in the contributions pharmacists can make within primary care, there is limited research which explores the competencies pharmacists need to safely and effectively provide care in this arena. Therefore, a modified eDelphi study was conducted between July 2019 and January 2020 among pharmacists working in General Practice in Scotland in order to (a) generate a list of competencies required to undertake pharmacotherapy tasks within General Practice using content analysis; and (b) establish consensus regarding the importance of these competencies using a rating scale ranging from 1 ("not important") to 10 ("very important"). A framework of competencies was developed, containing eight competency categories with a total of 31 individual competency items. Overall, study participants considered all eight competency categories as being important, with a mode of 10 and a median >8; agreement among participants was high, with the majority of individual competency items rated 8 or above by more than 75% of participants. There was, however, variation in responses with regards to specific tasks such as medicines reconciliation and medication compliance reviews. Findings indicate that the GP setting requires a broad set of competencies—covering areas including the use of IT systems; clinical knowledge; and communicating with patients and other healthcare professionals. This implies that further emphasis on clinical and consultation skills should be added to training programmes aimed at GP pharmacists; furthermore, ongoing support is also needed with regards to generic skills such as the use of IT systems, documentation, and general procedures and processes within primary care, some of which might need to be tailored to the specific practice context. [ABSTRACT FROM AUTHOR]

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Background: Advanced General Practice Clinical Pharmacists (GPCPs) are expected to manage patients by undertaking clinical assessment then make safe, competent autonomous decisions. Simulation provides a safe learning environment to develop clinical skills, but is rarely used for postgraduate pharmacist development.Aim: Design and deliver innovative simulation teaching to support Advanced GPCPs in Scotland.Setting: General Practice.Development: Experienced clinical pharmacy educators designed a simulation day with ten scenarios based on general practice clinical presentations. Learning objectives were mapped to the National Advanced GPCP competency framework.Implementation: Simulation took place at the National Skills Education Hub, Louisa Jordan National Hospital, Glasgow, November 2020. Participants were briefed prior to each immersive simulation. Mannequins were used if clinical signs were expected to be identified on examination. Verbal and written feedback was given after each simulation.Evaluation: Pre and post simulation questionnaires were developed. Increase in confidence and competence were reported in all areas pertaining to application of consultation and clinical skills. Qualitative comments from the participants regarding the training course were also favourable with respondents highlighting the value of the training, especially in terms of developing confidence via the real-time feedback.Conclusion: This innovative simulation evaluated as being of value to GPCPs in developing clinical confidence and competence when dealing with a variety of typical General Practice scenarios. Plans are underway to establish a Scottish Pharmacy Simulation Faculty which could support this training in each health board. [ABSTRACT FROM AUTHOR]

Background: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. Findings: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. Conclusion: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland. [ABSTRACT FROM AUTHOR]

Working in a cooperative manner with other disciplines or agencies is often cited as an essential element of social work with adults who self-neglect. Cooperative working is now a legal requirement for agencies involved in adult social care in England. However, little is known about how social workers engage cooperatively with other disciplines in practice. This study sets out to explore this issue, employing the 'Logic of Appropriateness' perspective to theorise the ways in which social workers talked about working with other disciplines in self-neglect casework. The article presents a qualitative study, which was undertaken through semi-structured interviews with eleven social workers in an urban, adult social care team in an English local authority. Thematic analysis was not only used to draw out four key logics used by the social workers—leadership, joint-working, conflict and proxy—but also highlighted the ways in which social workers moved between different logics when talking about inter-disciplinary cooperation and working with adults who self-neglect. The results highlight the complex dynamics of cooperation and suggest that these dynamics need to be understood in assessing the implementation of integrated policies for social care in this area. [ABSTRACT FROM AUTHOR]

Background: In the UK, pharmacist independent prescribers can prescribe for any condition within their clinical competence including systemic anti-cancer therapy. Competency frameworks have been developed but contain little detail on the patient assessment skills pharmacist independent prescribers require to prescribe systemic anti-cancer therapy with concern in the literature over current training on these skills. Aim: To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing systemic anti-cancer therapy for genitourinary cancer (prostate and renal) and lung cancer across National Health Service Scotland. Method: Two phases were performed to generate patient assessment skill consensus. Initially, the Nominal Group Technique was performed within a local cancer network by discussion and participant ranking within genitourinary and lung cancer multi-disciplinary teams. Where consensus was achieved, patient assessment skills were carried forward to try to achieve national (National Health Service Scotland) consensus using a two-round Delphi questionnaire. Results: Of the 27 patient assessment skills, consensus was gained for 21 and 23 patient assessment skills in the genitourinary and lung Nominal Group Technique groups, respectively. Within the genitourinary and lung national groups, 13/21 and 18/23 patient assessment skills were agreed as required for a pharmacist independent prescriber to prescribe systemic anti-cancer therapy in genitourinary and lung cancer, respectively. Eight common patient assessment skills were identified as core skills. Reasons for not reaching consensus included pharmacist independent prescriber competence, knowledge, skills and the roles and responsibilities of pharmacist independent prescribers within the multi-disciplinary team. Conclusion: We identified the core and specific patient assessment skills required to prescribe systemic anti-cancer therapy within two tumour groups. Further work is necessary to develop patient assessment skill competency frameworks, training and assessment methods and to redefine the roles of pharmacist independent prescribers within the multi-disciplinary team. [ABSTRACT FROM AUTHOR]

Addressing differential attainment between International Medical Graduates (IMGs) and their peers who hold UK Primary Medical Qualifications remains one of the most significant challenges facing postgraduate General Practice (GP) training. Enhanced Induction programme, such as the Scottish Trainee Enhanced Programme (STEP), is one tool designed to try and facilitate transition into training and reduce this inequity. The STEP course is attended by both the trainee and their educational supervisor, and aims to lay the foundations of a successful and supportive supervisory relationship. Previous work has evaluated this programme from the perspective of the trainee. Through the use semi-structured interviews, we evaluated the impact and the benefits of the programme from the perspective of the educational supervisors, building on the literature on interventions to support inequity in medical education.

Advanced clinical practice (ACP) roles evolved to fill gaps in healthcare provision and improve consistency in standards of care. Historically, variance in service specific requirements, combined with inconsistent approaches to role governance and education, resulted in a multitude of ACP roles and remits. Definitions of roles and titles vary, but there is agreement on academic level and role competency assessment. Irrespective of these definitions, staff and services need support to operationalise guidance. In Scotland, development of advanced practice roles is supported through regional NHS Advanced Practice Academies. One Scottish Board has initiated a local board level advanced care academy to fulfil the three key components of advanced practitioner development: master's level theoretical knowledge, effective supervision and robust clinical competency assessment in practice. This development model, known as the 'triangle of capability', has allowed rapid progress with the advanced practice agenda, which is a central component of sustainable healthcare provision. [ABSTRACT FROM AUTHOR]

Objective: The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation. Methods: Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice. Results: The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation. Conclusion: The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors' knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology. [ABSTRACT FROM AUTHOR]

In the United Kingdom, taking part in continuing professional development (CPD) is required for revalidation for general practitioners, general practice nurses and registered pharmacy staff – pharmacists and pharmacy technicians. The literature has many research studies which describe one profession's activities, or a specific learning method or topic. Few studies compared the CPD preferences across these four professional groups or compared their CPD activity. A survey was designed by the authors with assistance from colleagues within NHS Education for Scotland (NES). It was sent to the four professions and 2,813 clinicians responded. More than 75% of all respondents spent between 0 and 10 h per month on CPD activities. Participation in formal Protected Learning Time (PLT) varied across different NHS boards in NHS Scotland and ranged from 23.9% of respondents in the board with the lowest participation, to 68.6% in the board with the highest participation. All professions indicated a greatest preference to learn with other members of their profession. The preferred time for learning during the day varied amongst professions. The CPD activity of greatest preference for all professions was discussion with peers. There were some minor differences in learning preferences and activities from professionals working in remote and rural areas and in areas of socio-economic deprivation in Scotland. [ABSTRACT FROM AUTHOR]

NHS Scotland faces significant challenges in delivering the Scottish Government's 2020 Strategy for Healthcare. GP recruitment and retention are problematic for deprived area practices (DAPs). Recently-qualified GPs are more likely to join practices in areas where they have trained and so it is important to encourage GP training in deprived areas. This study aimed to identify the perceptions and experiences of recently-qualified GPs who had trained in DAPs. A grounded theory approach was used with 14 GPs interviewed in focus groups and in-depth interviews. Six themes were identified: allocation to training practices in deprived areas and anxieties about working there, positive training experiences, attributes of trainers, consultation differences, preferences for large practice teams and health centres, and future career plans. GPs were very positive about their training experiences in DAPs and appreciated their trainer and training practice. One concern was of the limited experience of patient-centred consulting which they felt weakened their performance in the Clinical Skills Assessment (CSA) component of the MRCGP examination. Rotations between affluent and deprived areas would benefit General Practice Specialty Trainees (GPSTs) particularly with the CSA examination. Training authorities should encourage and support practices in deprived areas to become training practices and encourage GPSTs to train there. [ABSTRACT FROM AUTHOR]

Leadership is one of the GMC's Generic Professional Capabilities for all medical specialties, but engagement in leadership activities is not currently routinely built into general practice (GP) training. We explored whether GP trainees in their first year of speciality training (ST1) could engage with a leadership activity in their practice placement. GP trainees were invited to participate in a voluntary leadership activity, with a small menu of optional activities to choose from. Evaluation was through electronic survey of trainees and educational supervisors (ESs) before and after the GP placement, and through trainee focus groups after the placement. 89 trainees and 191 supervisors were surveyed at the start of the trial. Trainees felt supported by supervisors and practice team members. Both groups felt that leadership skills were important for a trainee's future career. Supervisors placed more emphasis on this than trainees. Identified barriers included lack of protected time, other training priorities, lack of empowerment, and personal issues. Most trainees and their supervisors felt that a leadership activity was possible during the first year of general practice training. More work needs to be done to see if these results are generalisable to trainees across demographic subgroups, and in other years of training. [ABSTRACT FROM AUTHOR]

Sensory impairments are identified as the most common chronic and disabling conditions of later life, impacting significantly on the quality of life and safety of older adults. Hospitals and care environments can present significant challenges to older adults with sensory impairments. Therefore, it is important to raise awareness on sensory and cognitive impairments with all health professionals, and nurses in particular, both to help develop an empathetic awareness of the impact of impairment and to minimise risk of adverse events. This article reports on a pedagogical innovation on the development and use of a simulation resource—primarily on sensory impairments in older adults—with first-year nursing students in an undergraduate nursing programme in a Scottish university. The article also reports on students’ reflections on their experience of participating in this simulation. [ABSTRACT FROM AUTHOR]

Background: The Misuse of Drugs Act non-medical prescribing legislation permits nurse independent prescribers (NIPs) to prescribe any controlled drug that is within their scope of professional practice. Continuing professional development (CPD) is essential for safe effective prescribing and is required for professional revalidation. This study was conducted to explore the educational requirements of non-medical opioid prescribers. Methods: Informed by a critical realism position, an electronic survey was distributed to 147 NIPs working in a Scottish NHS Health Board. The aim was to identify how many NIPs were prescribing opioids and to explore their CPD requirements regardless of whether they prescribed opioids or not, including preferred method of delivery of education and to explore whether the single competency framework was sufficient to facilitate safe and effective prescribing. Results: The response rate was 46% (n=68). The majority of respondents (69%, n=37) prescribed opioids. Ninety-four percent of respondents (n=64) stated they felt that ongoing education was necessary to ensure safe opioid prescribing practice. Face-to-face methods of learning in small group discussions were the preferred option. Two thirds of the respondents (66%, n=45) felt that there should be protected time for prescribing CPD and 64% (n=27) felt the single competency framework provided a good standard for prescribing CPD. Conclusions: The results from this study suggest that nurses are prescribing opioids in acute and community hospitals. Group opioid education is recommended and using a structured competency framework to inform clinical practice may ensure safe, effective prescribing practice. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore final-year students’ experiences of the mentorship role in their final placement and, in particular, to establish their expectations of the mentorship role, as well as their support and supervision needs. Method: Seven final-placement students were recruited from one Scottish university, using purposive sampling. Heideggerian phenomenology was chosen as the underpinning philosophical approach because of its emphasis on the ‘lived experience’. Data were generated using unstructured interviews and analysed using a modified version of Colaizzi’s procedural steps. Results: Five themes emerged from the data: ‘being more independent’, ‘support’, ‘belongingness’, ‘feedback’ and ‘anticipatory anxiety’. Discussion: Participants who had a positive experience of mentorship were exposed to a ‘good’ learning environment. As a result, they felt supported, received adequate opportunities to practise management skills, had a sense of ‘belonging’ within the nursing team and had regular feedback. Those who had a negative experience complained of not getting the opportunity to develop essential management skills and being dismissed for trying to be proactive. In addition, feedback was reported to be lacking. This experience resulted in reduced confidence levels, which left them feeling unprepared for the transition to registered nurse. Conclusion: The clinical learning environment itself and support from the mentor are key factors that influence student preparation for registration. Without this level of support, students may be left feeling unprepared to deal with the transition. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is the most common cause of non-traumatic disability in young adults, with most diagnoses occurring between the ages of 25–49 years. Nutrition must be managed effectively and holistically to improve health and quality of life. Dysphagia management is collaborative and can enhance nutrition and hydration goals as well as reduce the risk of aspiration pneumonia. A case study demonstrates the specialist clinical skills and frameworks used to achieve nutrition, hydration, safety and patient focused outcomes. [ABSTRACT FROM AUTHOR]

Shifts in demographic profiles and in the understanding of how to best deliver health care have seen nurses increasingly caring for non-acute client groups outside traditional clinical settings. Evidence suggests that this does not always sit well with nurses, or with nurses in training. This study sought to investigate the influences on student nurse perceptions of the worth of working with various client groups. Thematic analysis of a focus group discussion led to the identification of several themes suggesting that unhelpful opinions are present in some students on entry to the programme; however, programme-related influences also contribute towards unhelpful attitudes. To create a more positive framing of working within such specialisms will require significant focus across nursing, nurse education and society in general. [ABSTRACT FROM AUTHOR]

Background: High body mass index (BMI) is an important contributor to the global burden of ill-health and health inequality. Lower socioeconomic position (SEP) in both childhood and adulthood is associated with higher adult BMI, but how these associations have changed across time is poorly understood. We used longitudinal data to examine how childhood and adult SEP relates to BMI across adulthood in three national British birth cohorts.Methods and Findings: The sample comprised up to 22,810 participants with 77,115 BMI observations in the 1946 MRC National Survey of Health and Development (ages 20 to 60-64), the 1958 National Child Development Study (ages 23 to 50), and the 1970 British Cohort Study (ages 26 to 42). Harmonized social class-based SEP data (Registrar General's Social Class) was ascertained in childhood (father's class at 10/11 y) and adulthood (42/43 years), and BMI repeatedly across adulthood, spanning 1966 to 2012. Associations between SEP and BMI were examined using linear regression and multilevel models. Lower childhood SEP was associated with higher adult BMI in both genders, and differences were typically larger at older ages and similar in magnitude in each cohort. The strength of association between adult SEP and BMI did not vary with age in any consistent pattern in these cohorts, but were more evident in women than men, and inequalities were larger among women in the 1970 cohort compared with earlier-born cohorts. For example, mean differences in BMI at 42/43 y amongst women in the lowest compared with highest social class were 2.0 kg/m2 (95% CI: -0.1, 4.0) in the 1946 NSHD, 2.3 kg/m2 (1.1, 3.4) in the 1958 NCDS, and 3.9 kg/m2 (2.3, 5.4) the in the 1970 BCS; mean (SD) BMI in the highest and lowest social classes were as follows: 24.9 (0.8) versus 26.8 (0.7) in the 1946 NSHD, 24.2 (0.4) versus 26.5 (0.4) in the 1958 NCDS, and 24.2 (0.3) versus 28.1 (0.8) in the 1970 BCS. Findings did not differ whether using overweight or obesity as an outcome. Limitations of this work include the use of social class as the sole indicator of SEP-while it was available in each cohort in both childhood and adulthood, trends in BMI inequalities may differ according to other dimensions of SEP such as education or income. Although harmonized data were used to aid inferences about birth cohort differences in BMI inequality, differences in other factors may have also contributed to findings-for example, differences in missing data.Conclusions: Given these persisting inequalities and their public health implications, new and effective policies to reduce inequalities in adult BMI that tackle inequality with respect to both childhood and adult SEP are urgently required. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

Background: The transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement worldwide, as for example in our 2014-15 study of an Incentivised Laparoscopy Practice programme (ILPv1). Drawing on learning from our subsequent multi-centre study examining barriers and facilitators, we revised the programme for 2018 onwards. We now report on engagement with the 2018-2022 versions of this home-based simulation programme (ILP v2.1-2.3)., Methods: In ILP v2.1-2.3, three consecutive year-groups of new-start Core Surgical Trainees (n = 48, 46 and 53) were loaned portable simulators. The 6-month education programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review (but not mandatory for progression). ILP was set within a wider reform, "Improving Surgical Training"., Results: ILP v2.1-2.3 saw pass rates of 94%, 76% and 70% respectively (45/48, 35/46 and 37/53 trainees), compared with only 26% (7/27) in ILP v1, despite now including some trainees not intending careers in laparoscopic specialties. The ILP v2.2 group all reported their engagement with the whole simulation strategy was hampered by the COVID19 pandemic., Conclusions: Simply providing take-home simulators, no matter how good, is not enough. To achieve trainee engagement, a whole programme is required, with motivated learners, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a "reform within a reform, within a context.", Competing Interests: Declaration of competing interest Paul Brennan, a clinical academic surgeon, is a shareholder in eoSurgical Ltd, Edinburgh, UK. He co-designed the eoSim simulator used in this programme and co-established the eoSurgical company which manufactures it. eoSurgical also markets the ‘InsTrac’ and ‘SurgTrac’ software used in this programme. Kenneth Walker, Satheesh Yalamarthi and Mark Vella are each part-employed and salaried by NHS Education for Scotland. Their roles include delivery of the Scottish IST pilot, of which the ILP programme is a part. KW is an Associate Postgraduate Dean (Simulation Lead); SY and MV are Core Surgery Training Programme Directors. Adarsh Shah, Laura Nicol, Vivienne Blackhall and Jennifer Cleland have no conflicts of interest or financial ties to disclose., (Copyright © 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. All rights reserved.)

Objective To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme ( NDIP) examinations. Methods A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry ( BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3t/D3T and ft/ FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. Results The mean kappa score was 0.84 ( SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 ( SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 ( SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 ( SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. Conclusion We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme. [ABSTRACT FROM AUTHOR]

In order to build the evidence base for interprofessional education and practice, it is important to establish how the concepts and theories are understood by higher education providers, policy-makers, managers, and practitioners. Using an interdisciplinary research approach, and facilitated by the use of visual images, we undertook a discourse analysis of interviews and discussions around definitions, competencies, and cultures of learning for interprofessional practice in the context of child health and social care in Scotland. Challenges to interprofessional practice were seen as generated within professional hierarchies and the complicatedness of working with chronic or multisystem disease. In order to work collaboratively, individual practitioners should understand the boundaries of their own knowledge and skills and demonstrate the capacity for interpersonal communication (within and between professions), as well as problem-solving and dealing with uncertainty. While there was agreement on these as key learning needs for collaborative working, the term interprofessional education was rarely used in practice by the interviewees and there was perception of a gap between university and workplace settings in supporting learning for interprofessional practice. It is recommended that educational frameworks acknowledge that the interprofessional learning journey is influenced by context and organisational culture. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine (1) nursing lecturers' and (2) preregistration nursing students' perspectives of user and carer involvement in the formal assessment of preregistration nursing students' clinical practice. Background The involvement of service users and carers in the assessment of clinical practice in nursing education is a recent phenomenon. The Nursing and Midwifery Council Standards in the UK clearly reflect a shift in thinking from paternalistic approaches to person-centred approaches. This shift in thinking includes service user and carer involvement in student nursing assessment and there is evidence that this is being developed in several countries. Design Located in the interpretive paradigm, data from a two-staged, multicentre qualitative study are presented. Methods Interpretive analysis of semi-structured, one to one interviews with nursing lecturers (n = 15) and focus groups with nursing students (n = 51) across 11 Higher Educational Institutions. Results There is a strong commitment for working alongside service users and carers in the education and training of nursing students; however, involving service users and carers in formal practice assessment is identified as more challenging compared with other areas of service user/carer involvement. Service user/carers should provide feedback/review or comment, but not necessarily formal, summative 'assessment'. Conclusions The evidence base for involving users and carers in assessment is limited. Involvement of users and carers in providing feedback to nursing students is welcomed. However, concerns exist about the preparedness of users and carers for formal clinical assessment. Relevance to clinical practice Discussion and clarification with clinical mentors and user and carer groups is necessary to understand if they agree with the policy direction of user and carer involvement in the assessment of nursing students. Quality assurance concerns are raised by students and lecturers when involving user and carer in assessing nursing students' clinical skills. Mentors are seen as key to this process, but little is known about their perspectives. [ABSTRACT FROM AUTHOR]

Objective:The sequential objective structured clinical exam (OSCE) is a stand-alone variation of the traditional OSCE whereby all students sit a screening test. Those who pass this initial assessment undergo no further testing while weakly performing students sit an additional (sequential) test to determine their overall pass/fail status. Our aim was to determine outcomes of adopting a sequential OSCE approach using different numbers of screening stations and pass marks. Method:We carried out a retrospective, observational study of anonymised databases of two cohorts of student outcomes from the final OSCE examination at the University of Aberdeen Medical School. Data were accessed for students (n = 388) who sat the exam in the years 2013–2014. We used Stata simulate program to compare outcomes – in terms of sensitivity and specificity – across 5000 random selections of 6–14 OSCE stations using random selections of groups of 100 students (with different screening test pass marks) versus those obtained across 15 stations. Results:Across 6–14 stations, the sensitivity was ≥87% in 2013 and ≥84% in 2014 while the specificity ranged from 60% to 100% in both years. Specificity generally increased as the number of screening stations increased (with concomitant narrowing of the 95% confidence interval), while sensitivity varied between 84 and 98%. Similar sensitivities and specificities were found with screening pass marks of +1, +2 and +3 standard errors of measurement (SEM). Eight stations as a screening test appeared to be a reasonable compromise in terms of high sensitivity (88–89%) and specificity (83–86%). Conclusion:This research extends current sequential OSCE literature using a novel and robust approach to identify the “ideal” in terms of number of screening stations and pass mark. We discuss the educational and resource implications of our findings and make recommendations for the use of the sequential OSCE in medical education. [ABSTRACT FROM PUBLISHER]

Background Improving and sustaining quality in healthcare continues to be a global challenge, resulting in the necessity of developing quality improvement (QI) skills and knowledge to use in practice. This paper reports student nurses’ experiences of conducting a quality improvement project (Practicum) as a compulsory assessment whilst on clinical placement areas across Scotland. Methods Telephone and face-to-face interviews (n = 18) were conducted using a semi-structured interview schedule. Discussions were transcribed verbatim and data were analysed thematically. Data were extracted from Practicum assignments (n = 50). Results Three key themes emerged from the analysis: 1) Time; students highlighted the necessity of time in practice areas to acclimatise, socialise and conduct the Practicum. Timing of the Practicum within the curriculum was also important. 2) Fear; was experienced by many students at the perceived enormity of the assignment, the bravery needed to attempt to change practice and the adjustment to a unique type of assignment. 3) Transformation; students shared their shifted perceptions on completing a Practicum, including a sense of achievement and acknowledgement of key improvement skills for the future. Conclusions Student nurses need to be stretched beyond their comfort zones to rise to the challenge of the Practicum, whilst ensuring adequate support mechanisms are in place from a range of sources. [ABSTRACT FROM AUTHOR]

Managers in healthcare services have ever-increasing demands to consider in relation to front line care, including the continuing professional education needs of qualified practitioners who are advancing their roles. One advancement is non-medical prescribing, and this article reports part of the findings from a survey undertaken in Scotland which explored managers' views of the clinical support of staff enrolled on a non-medical prescribing programme. The article discusses how managers have an important role to play in supporting these learners in practice, and suggests all stakeholders should be aware of the pressure this adds to managers, and seek creative solutions to support the process of learning. [ABSTRACT FROM AUTHOR]

NHS Education for Scotland is working with higher education institutions and other partners to contribute to recommendations outlined in Strengthening the Commitment, the UK-wide review of learning disability nursing. This article focuses on the recommendation to help undergraduates in adult, mental health and children's nursing to develop core knowledge and skills necessary to work safely and appropriately with people with learning disabilities in general health services. Traditional ways to help students gain experience of caring for people with learning disabilities have tended to depend on the commitment of individual lecturers, and consequently have been inconsistent. This article describes how the 'Thinking Space' approach was used to support lecturers and other professionals in enabling students to achieve required outcomes regarding learning disability care, and to meet the requirements of the review's recommendation. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper aims to explore student nurses' experiences of bioscience learning, teaching and application within the practice setting. It draws upon the social learning theory of communities of practice to consider the issues raised. Background The teaching of bioscience within many nursing curricula has shifted from traditional to more integrated approaches. Student nurses recognise bioscience as a valuable component of their studies, but many find it challenging. The focus of previous research in this area has often focussed on bioscience learning in theoretical rather than practice settings. Design A phenomenological study. Methods Data were collected via focus group or interview with a total of seven students across two campuses in a Scottish university. Participants were offered the opportunity to share their experiences at both the end of year one and year two of their studies. A thematic analysis was undertaken independently then jointly by the authors. Results The findings suggest that although participants recognise the value of bioscience within practice settings, they found that opportunities for learning were often limited. Bioscience-related learning, teaching and application was perceived to have been given less legitimacy by the practice setting than other aspects of placement activity. To enhance bioscience approaches participants expressed a desire for more structured and integrated approaches within both practice and university along with further peer learning opportunities. Conclusions Students recognise that bioscience knowledge is important in relation to the provision of safe and effective care. They request greater structure and consistency in relation to the learning, teaching and application of this topic during their placements. Relevance to clinical practice Those with a stake in educating nurses within clinical settings may find the views of student nurses on the topic of bioscience learning useful when planning and facilitating placement experiences. [ABSTRACT FROM AUTHOR]

Specialist environments have traditionally not been considered as practice learning environments for year one nursing students. Through implementation of the hub and spoke model of practice learning this was implemented across one health board and Higher Education Institution in Scotland. Sixty nine students from specialist and 147 from general areas out of a total population of 467 students (46.2%) and thirteen mentors from specialist and 26 from general areas out of a total 577 mentors (6.7%) completed a questionnaire. The findings support this initiative and suggest in some cases student experiences are more positive in specialist environments. [ABSTRACT FROM AUTHOR]

Background: International medical graduates (IMGs) are known to have significantly lower first attempt pass rates at the clinical skills assessment examination (CSA) than UK graduates. Whilst much has been published concerning higher fail rates in this group, there has been very little exploration of factors associated with success. Aims: This research aims to identify and explore factors associated with success in the CSA. Method: Telephone interviews with 10 IMGs who had passed the CSA on their first attempt were undertaken. Participants were current or recent (previous academic year) GP trainees in Scotland. Transcripts of the interviews were analysed by a thematic analysis approach. Results: Six main themes emerged from the data analysis. These were insights into the challenges, a proactive approach, refining consultation skills, learning with UK graduates, valuing feedback and supportive relationships. Conclusions: This research adds the much-needed voice and experience of IMGs to a current area of uncertainty and challenge in medical education. It provides some insights into potential solutions to the issues and will be of interest to both trainees and those involved in their education. [ABSTRACT FROM AUTHOR]

The recent much needed increase in the provision of evidenced-based psychological interventions, such as cognitive behaviour therapy (CBT), has created a demand for suitably trained and competent CBT supervisors in the UK. Simple training for this role is inadequate, so novice supervisors should also consider working with an experienced supervisor, having their supervision practice observed and seeking regular feedback on their supervisor competence. This encourages self-reflection and builds competence in supervision, which can lead to formal accreditation with the British Association for Behavioural and Cognitive Psychotherapies. [ABSTRACT FROM AUTHOR]

Introduction: The widely used Objective Structured Clinical Examination (OSCE) is undoubtedly expensive. Cost-effectiveness is one of the components of the assessment utility index defining its usefulness. Our current financial climate demands increased transparency in the costs associated with medical education and it is now vital to ascertain how much is spent on assessments, such as the OSCE, and in particular costs associated with the different types of stations within the OSCE. Methods: A retrospective case-study approach was used to identify all costs associated with the development, production, administration and post-examination phases of the 2013 final year MBChB OSCE at the University of Aberdeen, Scotland. This 15 station OSCE was held over 2 days for 185 students. Results: This OSCE cost £65,328 to run. Costs per station ranged from £3108 (prescribing) to £6577 (eye examination). The cost per student was £355. Discussion: The costs of a “high stakes” OSCE are sobering. The bulk of costs identified are not modifiable in light of what is currently known about the metrics of OSCE utility, particularly reliability and validity. Conclusion: Providers, and funders, of medical education must be prepared to assign significant resource to OSCE assessment and centres should be encouraged to calculate precise costs associated with assessment to inform resource allocation decisions. [ABSTRACT FROM PUBLISHER]

Linking theory to practice is an area of concern for ultrasound students, clinical mentors and academic staff. The link between theory and practice requires a robust clinical mentorship scheme in addition to careful curricula design considerations to improve student outcomes. The introduction of interactive technology in education provides ripe opportunity to improve feedback to students to support the link between theory and practice. A series of three interactive learning and teaching activities were designed and delivered to a PostGraduate Ultrasound cohort, after which, evaluation was performed to answer the research question: Which interactive technologies support the link between theory and practice through improved feedback mechanisms? An action research methodology was adopted involving an enquiry based literature review, planning, design and action process. Data were collected following action of three interactive teaching and learning sessions within the Medical Ultrasound cohort of 2013/2014 at Glasgow Caledonian University via a paper based questionnaire. A 100% response rate was achieved (n = 14). All three interactive learning and teaching sessions were considered with 100% highest point agreement to support the link between ultrasound theory and practice via feedback. Students found all three designed and facilitated sessions valuable and relevant to their learning, which in turn provided positive experiences which were perceived to support the link between theory and practice through feedback. These activities can be considered valuable in Postgraduate Ultrasound education. [ABSTRACT FROM AUTHOR]

Background: Central venous access devices (CVADs) are now a fundamental part of contemporary healthcare. Despite having many advantages, there are also complications associated with them. Evidence suggests that educating and training health professionals who maintain CVADs is essential for preventing such complications, however, the most effective approach for this training has not been evaluated. Aim: The aim of this study was to determine whether the introduction of an innovative educational intervention within a higher education institution (HEI) improved the confidence and knowledge of registered nurses dealing with CVADs. Methods: A survey design consisting of a self-completion questionnaire and open-ended questions was used. Results: This study demonstrated that nurses felt more confident following participation in the training. In addition, nurses discussed the advantages of training outside of the clinical setting as it provided them with a safe place to practise and gave them time to learn without interruption. The findings from this study suggest that the HEIs can provide an effective and safe environment for registered nurses to build confidence and knowledge in CVAD management. [ABSTRACT FROM AUTHOR]

The article presents news briefs regarding medical education and the Association for Medical Education In Europe (AMEE), including previews of events for the pending September 4-9, 2015 AMEE conference in Glasgow, Scotland, details regarding the AMEE Medical Education Fellowship Awards, and trivia questions and answers regarding medical education.

Background Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making. Design A prospective non-randomised controlled study. Methods 28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group received no feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21. Results At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3-7). The control group exhibited a comparable number of errors-with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4-7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0-3), representing a 76.4%fall (p<0.0001). In the control group the total number of errors also fell-from 76 to 44 (mean of 3.1 errors/student; median 3; range 1-5), representing a 42.1% reduction (p=0.0003). Conclusions Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended. [ABSTRACT FROM AUTHOR]