How Prepared are UK Medical Graduates for Practice? Final report from a programme of research commissioned by the General Medical Council

This programme of research aimed to understand the extent to which current UK medical graduates are prepared for practice. Commissioned by the General Medical Council, we conducted: (1) A Rapid Review of the literature between 2009 and 2013; (2) narrative interviews with a range of stakeholders; and (3) longitudinal audio-diaries with Foundation Year 1 doctors. The Rapid Review (RR) resulted in data from 81 manuscripts being extracted and mapped against a coding framework (including outcomes from Tomorrow's Doctors (2009) (TD09)). A narrative synthesis of the data was undertaken. Narrative interviews were conducted with 185 participants from 8 stakeholder groups: F1 trainees, newly registered trainee doctors, clinical educators, undergraduate and postgraduate deans and foundation programme directors, other healthcare professionals, employers, policy and government and patient and public representatives. Longitudinal audio-diaries were recorded by 26 F1 trainees over 4 months. The data were analysed thematically and mapped against TD09. Together these data shed light onto how preparedness for practice is conceptualised, measured, how prepared UK medical graduates are for practice, the effectiveness of transition interventions and the currently debated issue of bringing full registration forward to align with medical students’ graduation. Preparedness for practice was conceptualised as both a long- and short-term venture that included personal readiness as well as knowledge, skills and attitudes. It has mainly been researched using self-report measures of generalised incidents that have been shown to be problematic. In terms of transition interventions: assistantships were found to be valuable and efficacious for proactive students as team members, shadowing is effective when undertaken close to employment/setting of F1 post and induction is generally effective but of inconsistent quality. The August transition was highlighted in our interview and audio-diary data where F1s felt unprepared, particularly for the step-change in responsibility, workload, degree of multitasking and understanding where to go for help. Evidence of preparedness for specific tasks, skills and knowledge was contradictory: trainees are well prepared for some practical procedures but not others, reasonably well prepared for history taking and full physical examinations, but mostly unprepared for adopting an holistic understanding of the patient, involving patients in their care, safe and legal prescribing, diagnosing and managing complex clinical conditions and providing immediate care in medical emergencies. Evidence for preparedness for interactional and interpersonal aspects of practice was inconsistent with some studies in the RR suggesting graduates were prepared for team working and communicating with colleagues and patients, but other studies contradicting this. Interview and audio-diary data highlights concerns around F1s preparedness for communicating with angry or upset patients and relatives, breaking bad news, communicating with the wider team (including interprofessionally) and handover communication. There was some evidence in the RR to suggest that graduates were unprepared for dealing with error and safety incidents and lack an understanding of how the clinical environment works. Interview and audio-diary data backs this up, adding that F1s are also unprepared for understanding financial aspects of healthcare. In terms of being personally prepared, RR, interview and audio diary evidence is mixed around graduates’ preparedness for identifying their own limitations, but all data points to graduates’ difficulties in the domain of time management. In terms of personal and situational demographic factors, the RR found that gender did not typically predict perceptions of preparedness, but graduates from more recent cohorts, graduate entry students, graduates from problem based learning courses, UK educated graduates and graduates with an integrated degree reported feeling better prepared. The longitudinal audio-diaries provided insights into the preparedness journey for F1s. There seems to be a general development in the direction of trainees feeling more confident and competent as they gain more experience. However, these developments were not necessarily linear as challenging circumstances (e.g. new specialty, new colleagues, lack of staffing) sometimes made them feel unprepared for situations where they had previously indicated preparedness.

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study

Background: Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. 

Methods/design: This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making:1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers’ intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service. 

Discussion: The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence.Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act.

Understanding Desistance from Sexual Offending: A Thematic Review of Research Findings

Although there is a substantial body of work on desistance from crime in general, comparatively little is known about desistance from sexual crime. The broad aim of this paper is to provide an overview of the research methodology and preliminary findings from a recent empirical study on desistance from sexual offending conducted by the authors. Such findings have potentially important implications for policy and practice concerning sex offender risk assessment, treatment and management.

Behind the Headlines: Media Representation of Children and Young People in Northern Ireland:Summary of Research Findings

Funded by the Economic and Social Research Council this partnership project between the Childhood, Transition and Social Justice Initiative at Queen’s University and Include Youth focuses on the negative stereotyping of children and young people and the role and responsibilities of the media in the creation and transmission of negative images. Engaging with children, young people, organisations working with children and young people and media representatives, the project uses research evidence to explore negative media representation and its consequences for children’s rights, public reaction and policy initiatives in Northern Ireland. This report represents a summary of the findings of engagement with 141 children and young people. It outlines how they feel they are presented by the media and the impacts of this. It concludes by noting ways forward in challenging negative portrayals.

Assessing the Societal Impact of Research: The Relational Engagement Approach

Marketing and policy researchers seeking to increase the societal impact of their scholarship should engage directly with relevant stakeholders. For maximum societal effect, this engagement needs to occur both within the research process and throughout the complex process of knowledge transfer. A relational engagement approach to research impact is proposed as complementary and building upon traditional approaches. Traditional approaches to impact employ bibliometric measures and focus on the creation and use of journal articles by scholarly audiences, an important but incomplete part of the academic process. The authors suggest expanding the strategies and measures of impact to include process assessments for specific stakeholders across the entire course of impact: from the creation, awareness, and use of knowledge to societal impact. This relational engagement approach involves the co-creation of research with audiences beyond academia. The authors hope to begin a dialogue on the strategies researchers can make to increase the potential societal benefits of their research.

Beyond the Orange and the Green. The Diversification of the Qualitative Social Research Landscape in Northern Ireland.

The Northern Ireland conflict has been described as one of the most over-researched conflicts in the world. However, this is a relatively recent development. For many years, when the conflict was most intense, social scientists in Northern Ireland were silent and not vocal. The sectarian violence that dominated the life in Northern Ireland as well as the fact that the country was a fundamentally unjust society contributed to this silence. However, since the peace process began in the mid 1990s, a growing number of qualitative studies have been published, utilising one-to-one interviews and focus group discussions, in order to "make people's voices heard" and deal with the consequences of the so-called "Troubles". This paper looks into the emergence of a qualitative social research landscape in Northern Ireland beyond the conflict and explores issues so far neglected. It is argued that a number of factors have contributed to this, among them the availability of research funding to voluntary and community sector organisations that use their data to influence policy-making and equality legislation in a country which is still deeply divided along socio-religious lines.

Identity issues for looked after children with no knowledge of their origins - Implications for research and practice

In the area of child care policy and practice, the benefits for children who are separated from their birth parents of maintaining some form of connection with their family of origin is now widely accepted. The arguments in support of this are found mainly in research concerning adoption and stem from four inter-related themes: children's rights to know of their heritage and background; parents' rights to information about the well-being of their children; the benefits of having knowledge about origins; and concerns about the impact of not knowing. The effects on the developing identities of those who, for various reasons, are unlikely ever to know the details of their birth parent(s) is an under-researched issue. Karen Winter and Olivia Cohen use a case study to illustrate some of the gaps concerning knowledge in this area. They argue that there is much to be learnt from the development of research projects which have as their focus the accounts of children and young people, from a wide range of care arrangements, regarding identity issues where they have no connections with or knowledge about their birth parent(s).

Economic cost of age-related macular degeneration: a review of recent research

As the population of most developed countries ages so the prevalence of diseases such as age-related macular degeneration (AMD) are likely to increase. To facilitate planning and informed debate regarding making provisions for this disease it is important that we have a clear understanding of the economic impact of visual impairment associated with AMD. In this paper we assess the state of current knowledge based on a review of published evidence in scientific journals. Based on our assessment of the evidence we argue that the paucity of research studies on the subject and wide variation in estimates produced from the few studies available make it difficult to assess with confidence the likely average direct cost-of-illness associated with AMD. We further argue that significant gaps in our understanding of the costs of AMD (particularly in respect of indirect costs) also exist. Current research should be augmented by more comprehensive studies.

The impact of adversity in childhood on outcomes in adulthood: research lessons and limitations

Summary: Current UK Government policy is concerned with the possible connections between childhood adversity, social exclusion and negative outcomes in adulthood. Understanding the impact of adverse childhood experiences on outcomes in adulthood is therefore key to informing effective policy and practice. In this article, the research on the impact of childhood adversity on outcomes in adulthood is reviewed in the broad categories of: mental health and social functioning; physical health; offending; service use; and economic impact. The literature on resilience that focuses on those who experience adversity, but do not have associated negative outcomes is also briefly considered. The strengths and limitations of the range of research methods used are then examined. Findings: Previous studies have tended to focus on specific forms of adversity, predominantly abuse and neglect, and either: specific populations and specific outcomes; specific populations and general outcomes; or general populations and specific outcomes. This means there may be incomplete understanding of the inputs (the range of adverse experiences in childhood), the processes (how these may affect people) and the outcomes (across domains in adulthood). Applications: It is concluded that it is important for social work researchers to engage in the current debate about how to prevent harmful childhood adversity and there is an important gap in the research for more interdisciplinary large-scale general population studies that consider the full range of childhood adversity and associated impacts across time and the possible processes involved.

A Review of Demographic Ageing in the UK: Opportunities for Rural Research

Demographic ageing is a global phenomenon. UK policy and research have, until recently, focused on national trends and implications and largely viewed ageing as a 'pensions and care' problem. While other and more positive aspects are beginning to be acknowledged, regional, local, and rural impacts remain underinvestigated. This paper, by reviewing the literature from several disciplines and countries, introduces a series of research questions that could usefully inform future geographical inquiry. It argues that the nature, experiences, and consequences of demographic ageing will vary across space, stage in the life course and numerous aspects of our everyday lives. Our current knowledge and understanding are but the tip of the iceberg in terms of the research opportunities that lie ahead.