Showing papers by "General Medical Council published in 2020"

Rising to the challenge of multimorbidity

Abstract: Tuberculosis is a leading cause of infectious disease–related death worldwide; however, only 10% of people infected with Mycobacterium tuberculosis develop disease. Factors that contribute to protection could prove to be promising targets for M. tuberculosis therapies. Analysis of peripheral blood gene expression profiles of active tuberculosis patients has identified correlates of risk for disease or pathogenesis. We sought to identify potential human candidate markers of host defense by studying gene expression profiles of macrophages, cells that, upon infection by M. tuberculosis, can mount an antimicrobial response. Weighted gene coexpression network analysis revealed an association between the cytokine interleukin-32 (IL-32) and the vitamin D antimicrobial pathway in a network of interferon-γ– and IL-15–induced “defense response” genes. IL-32 induced the vitamin D–dependent antimicrobial peptides cathelicidin and DEFB4 and to generate antimicrobial activity in vitro, dependent on the presence of adequate 25-hydroxyvitamin D. In addition, the IL-15–induced defense response macrophage gene network was integrated with ranked pairwise comparisons of gene expression from five different clinical data sets of latent compared with active tuberculosis or healthy controls and a coexpression network derived from gene expression in patients with tuberculosis undergoing chemotherapy. Together, these analyses identified eight common genes, including IL-32, as molecular markers of latent tuberculosis and the IL-15–induced gene network. As maintaining M. tuberculosis in a latent state and preventing transition to active disease may represent a form of host resistance, these results identify IL-32 as one functional marker and potential correlate of protection against active tuberculosis.

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

Abstract: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.

A comparison of undergraduate outcomes for students from gateway courses and standard entry medicine courses

Abstract: Gateway courses are increasingly popular widening participation routes into medicine. These six year courses provide a more accessible entry route into medical school and aim to support under-represented students’ progress and graduation as doctors. There is little evidence on the performance of gateway students and this study compares attainment and aptitude on entry, and outcomes at graduation of students on the UK’s three longest running gateway courses with students studying on a standard entry medical degree (SEMED) course at the same institutions. Data were obtained from the UK Medical Education Database for students starting between 2007 and 2012 at three UK institutions. These data included A-levels and Universities Clinical Aptitude Test scores on entry to medical school and the Educational Performance Measure (EPM) decile, Situational Judgement Test (SJT) and Prescribing Safety Assessment (PSA) scores as outcomes measures. Multiple regression models were used to test for difference in outcomes between the two types of course, controlling for attainment and aptitude on entry. Four thounsand three hundred forty students were included in the analysis, 560 on gateway courses and 3785 on SEMED courses. Students on SEMED courses had higher attainment (Cohen’s d = 1.338) and aptitude (Cohen’s d = 1.078) on entry. On exit SEMED students had higher EPM scores (Cohen’s d = 0.616) and PSA scores (Cohen’s d = 0.653). When accounting for attainment and aptitude on entry course type is still a significant predictor of EPM and PSA, but the proportion of the variation in outcome explained by course type drops from 6.4 to 1.6% for EPM Decile and from 5.3% to less than 1% for the PSA score. There is a smaller significant difference in SJT scores, with SEMED having higher scores (Cohen’s d = 0.114). However, when measures of performance on entry are accounted for, course type is no longer a significant predictor of SJT scores. This study shows the differences of the available measures between gateway students and SEMED students on entry to their medical degrees are greater than the differences on exit. This provides modest evidence that gateway courses allow students from under-represented groups to achieve greater academic potential.

Guidelines on suicide amongst anaesthetists 2019

Abstract: Anaesthetists are thought to be at increased risk of suicide amongst the medical profession. The aims of the following guidelines are: increase awareness of suicide and associated vulnerabilities, risk factors and precipitants; to emphasise safe ways to respond to individuals in distress, both for them and for colleagues working alongside them; and to support individuals, departments and organisations in coping with a suicide.

Clinical prioritisation questions: A novel assessment tool to encourage tolerance of uncertainty?

Abstract: Uncertainty is a common and increasingly acknowledged problem in clinical practice. Current single best answer (SBA) style assessments test areas where there is one correct answer, and as the appro...

Calculated grades, predicted grades, forecasted grades and actual A-level grades: Reliability, correlations and predictive validity in medical school applicants, undergraduates, and postgraduates in a time of COVID-19

Abstract: Calculated A-level grades will replace actual, attained A-levels and other Key Stage 5 qualifications in 2020 in the UK as a result of the COVID-19 pandemic. This paper assesses the likely consequences for medical schools in particular, beginning with an overview of the research literature on predicted grades, concluding that calculated grades are likely to correlate strongly with the predicted grades that schools currently provide on UCAS applications. A notable absence from the literature is evidence on whether predicted grades are better or worse than actual grades in predicting university outcomes. This paper provides such evidence on the reduced predictive validity of predicted A-level grades in comparison with actual A-level grades. The present study analyses the extensive data on predicted and actual grades which are available in UKMED (United Kingdom Medical Education Database), a large-scale administrative dataset containing longitudinal data from medical school application, through undergraduate and then postgraduate training. In particular, predicted A-level grades as well as actual A-level grades are available, along with undergraduate outcomes and postgraduate outcomes which can be used to assess predictive validity of measures collected at selection. This study looks at two UKMED datasets. In the first dataset we compare actual and predicted A-level grades in 237,030 A-levels taken by medical school applicants between 2010 and 2018. 48.8% of predicted grades were accurate, grades were over-predicted in 44.7% of cases and under-predicted in 6.5% of cases. Some A-level subjects, General Studies in particular, showed a higher degree of over-estimation. Similar over-prediction was found for Extended Project Qualifications, and for SQA Advanced Highers. The second dataset considered 22,150 18-year old applicants to medical school in 2010 to 2014, who had both predicted and actual A-level grades. 12,600 students entered medical school and had final year outcomes available. In addition there were postgraduate outcomes for 1,340 doctors. Undergraduate outcomes are predicted significantly better by actual, attained A-level grades than by predicted A-level grades, as is also the case for postgraduate outcomes. Modelling the effect of selecting only on calculated grades suggests that because of the lesser predictive ability of predicted grades, medical school cohorts for the 2020 entry year are likely to under-attain, with 13% more gaining the equivalent of the current lowest decile of performance, and 16% fewer gaining the equivalent of the current top decile, effects which are then likely to follow through into postgraduate training. The problems of predicted/calculated grades can to some extent, although not entirely, be ameliorated, by taking U(K)CAT, BMAT, and perhaps other measures into account to supplement calculated grades. Medical schools will probably also need to consider whether additional teaching is needed for entrants who are struggling, or might have missed out on important aspects of A-level teaching, with extra support being needed, so that standards are maintained. “… the … exam hall [is] a level playing field for all abilities, races and genders to get the grades they truly worked hard for and in true anonymity (as the examiners marking don’t know you). [… Now we] are being given grades based on mere predictions.” Yasmin Hussein, letter to The Guardian, March 29th 2020 [1]. “[Let’s] be honest, this year group will always be different.” Dave Thomson, blogpost on FFT Educational Lab [2] “One headmistress commented that ‘entrance to university on teachers’ estimates may be fraught with unimagined difficulties’. … If there is in the future considerable emphasis on school assessment, some work of calibration is imperatively called for.” James Petch, December 1964[3].

Experiential Learning Theory

Abstract: This chapter summarises the work of David Kolb who has advanced the earlier work of Dewey, Lewin and Piaget on experiential theory (ELT). Kolb’s model of ELT is considered in terms of its development from the basic concept that knowledge is created as a result of experience. This process is mediated through a number of learning styles which leads to the production of specific types of knowledge. An individual’s preferred learning style is determined through the application of the learning style inventory. Individuals also exhibit preferred backup learning styles when their primary learning style is not delivering the required solutions to the problems to which they are applied.

Overview to Synthesis

Abstract: This chapter considers concepts not previously covered which are necessary for the development of the conceptual framework for the acquisition, development and refining of professional skills.

Skill, Competence and Assessment Revisited

Abstract: This chapter brings together the material covered in Chap. 3– 9 to develop a deeper understanding of the nature of skilled activity from a predominantly neurophysiological and cognitive perspective. It uses the Dreyfus and Dreyfus model to provide a framework for this deeper understanding. A structure for psychomotor performance is described based on the system used in clinical resuscitation courses but extending it into application of the psychomotor activity into clinical practice. A basic unit of skilled activity is described: the skill set. This is mapped to the Dreyfus and Dreyfus model to produce an integrated model. Based upon that work formal definitions for competence and performance are offered along with a consequential modification to Miller’s framework.

Theories of Action

Abstract: This chapter reviews the work of Argyris and Schon into the behavioural worlds we inhabit and how we can come to understand them and influence them. Argyris and Schon propose that we can come to a greater understanding of these behavioural worlds by understanding our theories of action and how these influence our behavioural and thus the behavioural worlds we interact with. They propose models of behaviour which can positively impact on our actions which leads to more positive behaviours. They describe single- and double-loop learning and Model I and Model II behaviour.

Audio/visual recording of doctors in hospitals: Guideline from the Association of Anaesthetists

Abstract: Guidelines are presented that summarise the legal position regarding the audio/visual recording of doctors and others in hospitals. In general, there are few, if any, legal grounds for refusing a request by patients to record procedures and/or discussions with clinicians, although some staff may feel uncomfortable being recorded. Trusts and others are advised to draw up local policies and ensure staff and patients are adequately informed.

Assessment and Appraisal

Abstract: This chapter considers assessment and appraisal. It reviews the current literature on the definition of assessment and appraisal. It defines the different types of assessment: formative, summative and ipsative. The various tools available for assessment are considered. Miller’s framework for the assessment of clinical skills, competence and performance is reviewed and finally The General Medical Council enhanced appraisal system is discussed.

Brain Plasticity, Learning and Memory

Abstract: This chapter considers the relationship between learning and memory, the types of learning and their characteristics and the neurophysiological processes underlying them.

Tacit Knowledge Revisited

Abstract: This chapter brings together the material covered in Chaps. 1– 6 and Chap. 10 to develop a deeper understanding of the nature of tacit knowledge from a predominantly neurophysiological and cognitive perspective. This compliments the work of Polanyi and Collins discussed in the chapter on tacit knowledge. A structure for knowledge comprising three domains is described which spans the full range from explicit to tacit knowledge.

Racism in the NHS: focus on learning rather than blame

Abstract: The BMJ ’s timely and thought provoking special issue on racism in medicine (15 February 2020) provides a great insight into areas that concern us all and that demand systemwide change.1 The worrying experiences …

GMC is committed to supporting staff grade, associate specialist, and specialty doctors

Abstract: Wield is right to point out that staff grade, associate specialist, and specialty (SAS) doctors make a vital contribution to clinical care and that too often that contribution is overlooked.1 But it would be wrong to say that the General Medical Council fails to recognise their plight. We recently published …

Constructivism and Objectivism

Abstract: This chapter considers the two major educational paradigms of the twentieth and twenty-first century, objectivism and constructivism. It reviews the contributions to constructivism of its major proponents, Vygotsky (zone of proximal development and more capable peer), Bruner (scaffolding) and Piaget (schemas). It goes on to consider Piaget’s schemas in light of Eraut’s work on routinisations.

Theories of Action and Transforming Thought into Action Revisited

Abstract: This chapter brings together the material covered in Chap. 11 and extends it by incorporating Maslow’s Hierarchy of Needs and Herzberg’s Hygiene and Motivational Factors to develop a deeper understanding of the nature of theories of action. This will form the basis of a comprehensive model to be described in the next chapter.