Search

Background: The Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA. Methods: We employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses. Results: Overall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates' data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates' performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners' difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment. Conclusion: The RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement. [ABSTRACT FROM AUTHOR]

The scientific question of whether protracted low-dose or low-dose-rate exposure to external radiation is causally related to the risk of circulatory disease continues to be an important issue for radiation protection. Previous analyses of a matched case-control dataset nested in a large cohort of UK nuclear fuel cycle workers indicated that there was little evidence that observed associations between external radiation dose and ischemic heart disease (IHD) mortality risk [OR = 1.35 (95% CI: 0.99–1.84) for 15-year-lagged exposure] could alternatively be explained by confounding from pre-employment tobacco smoking, BMI or blood pressure, or from socioeconomic status or occupational exposure to excessive noise or shiftwork. To improve causal inference about the observed external radiation dose and IHD mortality association, we estimated the potential magnitude and direction of non-random errors, incorporated sensitivity analyses and simulated bias effects under plausible scenarios. We conducted quantitative bias analyses of plausible scenarios based on 1,000 Monte Carlo samples to explore the impact of exposure measurement error, missing information on tobacco smoking, and unmeasured confounding, and assessed whether observed associations were reliant on the inclusion of specific matched pairs using bootstrapping with 10% of matched pairs randomly excluded in 1,000 samples. We further explored the plausibility that having been monitored for internal exposure, which was an important confounding factor in the case-control analysis for which models were adjusted, was indeed a confounding factor or whether it might have been the result of some form of selection bias. Consistent with the broader epidemiological evidence-base, these analyses provide further evidence that the dose-response association between cumulative external radiation exposure and IHD mortality is non-linear in that it has a linear shape plateauing at an excess risk of 43% (95% CI: 7–92%) on reaching 390 mSv. Analyses of plausible scenarios of patterns of missing data for tobacco smoking at start of employment indicated that this resulted in relatively little bias towards the null in the original analysis. An unmeasured confounder would have had to have been highly correlated (rp > 0.60) with cumulative external radiation dose to importantly bias observed associations. The confounding effect of "having been monitored for internal dose" was unlikely to have been a true confounder in a biological sense, but instead may have been some unknown factor related to differences over time and between sites in selection criteria for internal monitoring, possibly resulting in collider bias. Plausible patterns of exposure measurement error negatively biased associations regardless of the modeled scenario, but did not importantly change the shape of the observed dose-response associations. These analyses provide additional support for the hypothesis that the observed association between external radiation exposure and IHD mortality may be causal. [ABSTRACT FROM AUTHOR]

The empirical estimation of cancer risks in children associated with low-dose ionising radiation (<100 mSv) remains a challenge. The main reason is that the required combination of large sample sizes with accurate and comprehensive exposure assessment is difficult to achieve. An international scientific workshop, 'Childhood cancer and background radiation', organised by the Institute of Social and Preventive Medicine of the University of Bern, brought together researchers in this field to evaluate how epidemiological studies of background radiation and childhood cancer can best improve our understanding of the effects of low-dose ionising radiation. This review summarises and evaluates the findings of these studies with regard to their methodological differences, identifies key limitations and challenges, and proposes ways to move forward. Large childhood cancer registries, such as those in Great Britain, France and Germany, now permit the conducting of studies that should have sufficient statistical power to detect the effects predicted by standard risk models. Nevertheless, larger studies or pooled studies will be needed to investigate disease subgroups. The main challenge is to accurately assess children's individual exposure to radiation from natural sources and from other sources, as well as potentially confounding non-radiation exposures, in such large study populations. For this, the study groups should learn from each other to improve exposure estimation and develop new ways to validate exposure models with personal dosimetry. [ABSTRACT FROM AUTHOR]

An inventory to measure students' perceptions of learning environments was developed and tested in five medical schools. Broad similarities were found but with a few substantial differences. Further research is recommended to overcome inconsistencies in the study. (MSE)

The article discusses the effectiveness of the Qualified Lawyers Transfer Scheme for lawyers to qualify as solicitors in England and Wales.

Background Concern exists regarding differential performance of candidates in postgraduate clinical assessments by ethnicity, sex, and country of primary qualification. Could examiner bias be responsible? Aim To explore whether candidate demographics affect examiners' judgements, by investigating candidates' case performances by candidates' and examiners' demographics. Design and setting Data on 4000 candidates (52 000 cases) sitting the MRCGP clinical skills assessment in 2011-2012. Method Univariate analyses were undertaken of subgroup performance (male/female, white/ black and minority ethnic (BME), UK/non-UK graduates) by parallel examiner demographics. Due to confounding of variables, these were complemented by multivariate ANOVA and multiple regression analyses. Results Univariate analysis showed some differences between outcomes between the same-group and other-group examiners: these were contradictory regarding examiners 'favouring their own', for example, males received higher marks from female examiners than from males: maximum effect size was 3.6%. A six-way ANOVA confirmed all three candidate and examiner variables as having significant effects individually, identifying one significant interaction (examiner sex by examiner ethnicity). Stepwise regression showed candidate variables predicting 12% of score variance, parallel examiner demographics adding little (approximately 0.2% of variance). One 'transactional' variable proved significant, explaining 0.06% of score variance. Conclusion Examiners show no general tendency to 'favour their own kind'. With confounding between variables, as far as the impact on candidates' case scores, substantial effects relate to candidate and not examiner characteristics. Candidate-examiner interaction effects were inconsistent in their direction and slight in their calculated impact [ABSTRACT FROM AUTHOR]

The article reports on international medical graduates (IMG)'s relative under-performance in the MRCGP AKT and CSA examinations. It is stated that IMGs form an important and valued part of the British medical workforce. Despite efforts to become nationally self-reliant for doctors, 37% of all doctors currently active on British GMC's list of registered medical practitioners (LRMP) are not British graduates.

This survey reports the views of 101 specialty registrar (StR) candidates of the consulting skills module of the Royal College of General Practitioners' membership exam (MRCGP). Overall StRs believed that preparing for the module improved their consulting with patients. They found the video workbook easy to understand, helpful and informative. While they found the performance criteria (PC) easy to understand and perform, the merit criteria were harder to demonstrate. Of those candidates responding, most found that a consultation length of 15 minutes was sufficient to demonstrate the PCs. However, almost 40% believed that a consultation time of 15 minutes is unrealistic in UK general practice. [ABSTRACT FROM AUTHOR]

The article presents information on occupational exposure, compensation, and epidemiology. Occupational exposures in Great Britain from 1998-2003 have been reviewed by the Health Protection Agency. The first epidemiological evidence that radiation increases the risk of cancer was provided by occupational exposure to ionizing radiation. In Great Britain, a compensation scheme for cancers caused by radiation was introduced by British Nuclear Fuels plc in 1982. A government-sponsored compensation scheme in the U.S. for radiation workers is also noted.

Discusses selection criteria for medical school and university applicants in Great Britain. Idea that intellectual aptitude tests should be considered along with the top grades at A level; Why A levels can predict outcome in medicine; The potential legal challenge from using intellectual aptitude testing to select medical students; Suggestion in the Tomlinson Report for introducing A+ and A++ grades; The argument for testing non-cognitive variables such as interpersonal communication skills, motivation, and probity.

Presents several letters related to the field of medicine in Great Britain. Issues on the use of chaperons during medical examinations; Capacity of iron in retinopathy of prematurity; Association between car traffic density and respiratory health of children.

The learning environment of teaching institutions is increasingly coming under scrutiny as an important determinant of educational process and outcome. This study examined medical students' perceptions of the learning environment of their medical schools. Substantial differences between the 25 participating schools in Britain and Ireland were found on some dimensions (e.g. vocational as opposed to 'scientific' orientation; level of student involvement in curricular affairs; perceived intensiveness of the course). Slight differences only were noted as to schools' administrative flexibility, the extent to which concepts are emphasised rather than factual detail (they are not), and the enjoyability of courses (high). Profiles of medical schools as perceived by the students are described and the validity and consistency of the findings reviewed. [ABSTRACT FROM AUTHOR]

Investigates the influence of research training as an undergraduate on career development in Great Britain. Correlation of the experiences with research performance; Prevalence of graduates with intercalated BSc in the clinical specialties; Provision of research grants for non-clinical specialties in Oxford and Cambridge.

Editorial. Comments on the state of assessment of clinical students in Great Britain. Investigation of undergraduate system; Issue of competence versus performance; Assessment of problem-solving ability.

Analyzes the attitudes, medical philosophy and political views of doctors Great Britain. Development of questionnaire distributed to medical doctors; Differences in the opinions of doctors on the justification for the loss of animal life in pharmaceutical researches; Comparison of the responses regarding the attitudes of doctors towards patients.

Examines the use of the database of Excerpta Medica to measure the output of medical research in Great Britain. Changes in the research outputs in research centers; Increase in the proportion of clinical papers; Necessity to devise a measurement of the importance of each paper.

Determines the existence of discrimination against Asian doctors in the membership examination for the Royal College of General Practitioners (MRCGP) in Great Britain. Analysis of data from the five administrations of the MRCGP examination; Comparison on the performance among Asian doctors; Conclusion that examination does not discriminate Asian doctors. INSET: MATERIA PARAMEDICA.

Focuses on the advantages of establishing a code of practice on medical student selection in Great Britain. Problem of selecting medical students for undergraduate courses; Differences in policies and practices of medical schools; Appropriateness and fairness of the code.

The authors reflect on the assessment of general practitioners (GP) in postgraduate training in Great Britain. They examine fairness and equality of the assessments, particularly on the issue of ethnic differences in GP attainment. The author suggests an agenda to guide future research within the scientific and academic community. An overview of the four key research areas that future research designs and methodologies should focus as suggested by the authors is provided.

A letter to the editor is presented in response to an article in the October 17, 2015 issue on the equality impact assessment of the junior doctor contract.

Responds to Rudi H. Nussbaum's letter criticizing Richard Wakeford's reply to Wing and Richardson that incorrectly claimed that an excess risk of childhood cancer was not experienced by the Japanese atomic bomb survivors who were irradiated in utero. Need for Nussbaum to explain why he contests the conclusions published in the scientific literature; Operation of a voluntary compensation program by British Nuclear Fuels and almost all of the other major employers in Great Britain.

A letter to the editor is presented in response to the article "Fire the Medical Schools Council if you want more GPs" by R. Wakeford in the October 28, 2014 issue.

The author contends that hospital doctors are over-represented in the representative body of medical schools in Great Britain. He says that the National Health Service (NHS) needs more general practitioners (GP) right away. He also discussed how the radical solutions to the workforce problem must include considering recruitment and retention.

Focuses on the entrance examinations of clinical medical students in Great Britain. Background of the Society of Apothecaries of London; Concept of a second rate qualification; Difficulties encountered by examiners.

Examines the impact of medical school training on the nutritional awareness of doctors in Great Britain. Increase awareness of older graduates on nutrition; Relation between undergraduate teaching and nutritional awareness; Implication for undergraduate teaching of nutrition.

Focuses on the quality of higher education for undergraduates and post-graduate in Great Britain. Impact in the medical schools; Requirement of the membership examination of the Royal College of General Practitioners by clinical medical schools; Use of log-linear model in the training program.

The article presents a study on the performance of foreign medical graduates, who passed the Professional and Linguistic Assessments Board (PLAB) exam, at MRCP and MRCGP examinations compared to those of British medical graduates. It discusses the findings on PLAB as an indicator of MRCP and MRCGP performance, and the workforce implications of raising the pass marks and improving the PLAB standards.

The article discusses standards expected of doctors in Great Britain regarding their fitness to practise. Baker proposes that focus groups which include professionals and the public should detail minimum standards. This proposal is unrealistic and unworkable for a number of reasons. The medical profession is too complex and changeable. The work of doctors is case specific and cannot be analysed by straightforward criteria. Weakness of current medical regulation should be addressed. However, medicine is rarely straightforward. INSET: Doctors' work.

In the United Kingdom, the Nuclear Installations Act 1965 places a 'strict' statutory duty on the operators of nuclear facilities to ensure that any exposure to radiation resulting from operations does not cause injury or damage. A claimant does not have to prove fault to receive compensation under the Act, only causation. The 1965 Act has been fundamental in shaping litigation involving the nuclear industry in the UK. Civil law cases brought under the Act will be heard before a single judge (with no jury or technical assessor) who must present his or her decision in a reasoned judgment. This process leads to a considerable volume of expert evidence being presented to the court and extensive cross-examination of witnesses. The expense and uncertainoutcome of cases involving claims by nuclear workers that occupational exposure to radiation had caused the development of cancer has ledto employers and trade unions setting up the voluntary Compensation Scheme for Radiation-linked Diseases as an alternative to litigation.This Scheme has worked well and is held up as a model of alternativedispute resolution. However, a few cases concerning personal injury or damage to property have come before the courts when the defendant nuclear operator considered that the claims were technically unjustified and where settlement was not a policy option. As anticipated, these cases were lengthy, complex, and expensive. The radiation doses assessed to have been received by the individuals who were the subject of claims, whether workers or members of the public, have been crucial to the outcome. The technical expertise of health physicists and allied specialists has been vital in establishing defensible estimates of dose, and this contribution can be expected to remain of high importance in radiation litigation in the UK. [ABSTRACT FROM AUTHOR]

The assumption that any additional exposure to ionizing radiation leads to an increase in the risk of stochastic health effects implies that some cases of these effects will be caused by exposure incurred occupationally. The main health effect expected to arise in the exposed individuals is cancer. Such radiation-induced cancers cannot be distinguished from the far larger number of background cancers, and, therefore, causation must be assessed statistically. The probability of causation methodology has been developed to ascertain the likelihood that a particular cancer may be attributed to a particular prior exposure to radiation. Given the pertinent details of an individual case,a probability of causation value is calculated from the appropriate relative risk obtained from radiation risk models derived from the epidemiological study of exposed populations, although there are many uncertainties inherent in a particular probability of causation calculation. In the United Kingdom, the Compensation Scheme for Radiation-linked Diseases has been created to determine whether those individuals occupationally exposed to radiation in the nuclear industry who have subsequently developed a malignant disease should be compensated. The Scheme is a voluntary arrangement based upon the probability of causation methodology, which incorporates various procedures agreed by employer and employee representatives and their advisers. In a pragmatic approach to compensation, the uncertainties of a specific probability of causation calculation are accommodated through generosity factors which favor the claimant and encourage the use of the Scheme. The Scheme, which was introduced in 1982 and modified in 1987 and 1991 in the light of operational experience and revised risk estimates, has provided a successful alternative to litigation from the point of view of both employer and employee. [ABSTRACT FROM AUTHOR]

The Recorded Consultation Assessment (RCA) was rapidly developed to replace the Clinical Skills Assessment (CSA) for UK general practice licencing during COVID-19. We aimed to evaluate candidate perceptions of the RCA and relationships with performance. We conducted a cross-sectional survey of RCA candidates with attitudinal, demographic, and free text response options, undertaking descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text. Binomial regression was used to estimate associations between RCA pass, candidate characteristics and questionnaire responses.645 of 1551 (41.6%) candidates completed a questionnaire; 364 (56.4%) responders permitted linkage with performance and demographic data. Responders and non-responders were similar in exam performance, gender and declared disability but were significantly more likely to be UK graduates (UKG) or white compared with international medical (IMG) or ethnic minority graduates. Responders were positive about the digital platform and support resources. A small overall majority regarded the RCA as a fair assessment; a larger majority reported difficulty collecting, selecting, and submitting cases or felt rushed during recording.Logistic regression showed that ethnicity (white vs minority ethnic: odds ratio [OR] 2.99,95% confidence interval [CI] 1.23, 7.30, p = 0.016), training (UK vs IMG: OR 6.88, 95% CI 2.79, 16.95, p < 0.001), and English as first language (OR 5.11, 0% CI 2.08, 12.56, p < 0.001) were associated with exam success but questionnaire subscales, consultation type submitted, or extent of trainer review were not. The RCA was broadly acceptable but experiences were variable. Candidates experienced challenges and suggested areas for improvement.

The potential for adverse health effects from internal exposure to Plutonium has been recognised since its discovery in the 1940s. However, in the absence of specific information, potential risks from Plutonium exposure have always largely been controlled through knowledge of radiation exposure risks in general, much of which comes from external radiation exposures. To try to obtain more direct estimates of potential internal exposure risks, epidemiological studies of Plutonium workers need to be conducted. Such epidemiological analyses require individual Plutonium exposure estimates that are as accurate and unbiased as possible. The UK Sellafield workforce includes one of the world's largest cohorts of Plutonium workers, which constitutes, by some considerable margin, the group of workers most comprehensively monitored for internal exposure to this alpha-particle-emitter. However, for several hundred workers employed at the start of Plutonium work at the facility, during the period from 1952 through to 1963, the historical urinalysis results available cannot provide sufficiently accurate and unbiased exposure assessments needed for use in epidemiological studies. Consequently, these early workers have had to be excluded from epidemiological analyses and this has significantly reduced the power of these studies. A promising quantitative methodology to overcome the issue of missing or deficient exposure data, is to use exposure data from other sources to estimate the average exposure a 'typical worker' would have received, and to collate this information for specific occupations and years. This approach is called a Job-Exposure Matrix (JEM). Work on a pilot study to construct a population-specific quantitative JEM for the early Plutonium workers at Sellafield during 1952-1963, for whom reliable urinalysis results do not exist, has shown the potential for a JEM approach to produce more reliable and useful exposure estimates for epidemiological research.

Plutonium is a radiologically significant alpha-particle emitter. The potential for adverse health effects from internal exposures due to plutonium intakes has been recognized since the 1940s. The workforce of the Sellafield nuclear facility (Cumbria, UK), includes one of the world's most important groups of plutonium-exposed workers for studying the potential health risks of this internal exposure. However, for several hundred workers employed at the start of plutonium work at the facility (1952-1963), historical monitoring records based on measurements of urinary excretion of plutonium are not sufficiently reliable to provide the accurate and unbiased exposure assessments needed for epidemiological studies. Consequently, these early workers have had to be excluded from such studies, significantly reducing their power. We constructed a population-specific quantitative job exposure matrix (JEM) to estimate the average intakes of "typical plutonium workers" in this period, from 1952-1963, and assessed its validity and sensitivity to exposure assessment decisions. We conducted internal cross-validation using an a priori 10% extracted sample to evaluate reliability of estimates, explored JEM sensitivity to assumptions in the exposure assessment, and assessed the impact of uncertainty in urinalysis measurements on the precision of annual intake estimates using Markov Chain Monte Carlo (MCMC) methodology. Pairwise correlations ( R P ) of estimated (JEM) and measured (10% sample) annual intakes were moderate to high ( R P > 0.4) for 10 out of 13 JEM groups, while absolute differences were <20% for 11 out of 13 JEM groups. There was little evidence of a temporal trend in correlations ( P = 0.13) or absolute differences ( P = 0.34). The median JEM-derived cumulative intake of 95.2 (IQR, 55.0-130.0) Bq was comparable to those based on alternative assumptions in the exposure assessment (median range, 95.2-100.0 Bq; 75th percentiles, 130.0-146.0 Bq). Measurement error simulation resulted in a 40-60% reduced median cumulative intake but higher maximum cumulative intakes. The JEM finds a balance between reliability and precision that makes it useful for epidemiological purposes and is relatively insensitive to specific choices in the exposure assessment. This JEM will allow the inclusion of workers with longest follow-up and who could not be included up until now in epidemiological studies without introducing significant bias.

Background: The predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK's General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance., Methods: Examination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n = 27,561) or Clinical Skills Assessment (CSA; n = 17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n = 37,358), Part 2 (MCQ; n = 28,285) or Practical Assessment of Clinical Examination Skills (PACES; n = 27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor's registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values., Results: Doctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen's d across the five exams of - 0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels., Conclusions: MRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.

Background: MRCGP and MRCP(UK) are the main entry qualifications for UK doctors entering general [family] practice or hospital [internal] medicine. The performance of MRCP(UK) candidates who subsequently take MRCGP allows validation of each assessment. In the UK, underperformance of ethnic minority doctors taking MRCGP has had a high political profile, with a Judicial Review in the High Court in April 2014 for alleged racial discrimination. Although the legal challenge was dismissed, substantial performance differences between white and BME (Black and Minority Ethnic) doctors undoubtedly exist. Understanding ethnic differences can be helped by comparing the performance of doctors who take both MRCGP and MRCP(UK)., Methods: We identified 2,284 candidates who had taken one or more parts of both assessments, MRCP(UK) typically being taken 3.7 years before MRCGP. We analyzed performance on knowledge-based MCQs (MRCP(UK) Parts 1 and 2 and MRCGP Applied Knowledge Test (AKT)) and clinical examinations (MRCGP Clinical Skills Assessment (CSA) and MRCP(UK) Practical Assessment of Clinical Skills (PACES))., Results: Correlations between MRCGP and MRCP(UK) were high, disattenuated correlations for MRCGP AKT with MRCP(UK) Parts 1 and 2 being 0.748 and 0.698, and for CSA and PACES being 0.636. BME candidates performed less well on all five assessments (P < .001). Correlations disaggregated by ethnicity were complex, MRCGP AKT showing similar correlations with Part1/Part2/PACES in White and BME candidates, but CSA showing stronger correlations with Part1/Part2/PACES in BME candidates than in White candidates. CSA changed its scoring method during the study; multiple regression showed the newer CSA was better predicted by PACES than the previous CSA., Conclusions: High correlations between MRCGP and MRCP(UK) support the validity of each, suggesting they assess knowledge cognate to both assessments. Detailed analyses by candidate ethnicity show that although White candidates out-perform BME candidates, the differences are largely mirrored across the two examinations. Whilst the reason for the differential performance is unclear, the similarity of the effects in independent knowledge and clinical examinations suggests the differences are unlikely to result from specific features of either assessment and most likely represent true differences in ability.