Patient safety and communication: A new assessment for doctors trained in countries where language differs from that of the host country: Results of a pilot using a domain-based assessment

Objective

Global migration of healthcare workers places responsibility on employers to comply with legal employment rights whilst ensuring patient safety remains the central goal. We describe the pilot of a communication assessment designed for doctors who trained and communicated with patients and colleagues in a different language from that of the host country. It is unique in assessing clinical communication without assessing knowledge.

A 14-station OSCE was developed using a domain-based marking scheme, covering professional communication and English language skills (speaking, listening, reading and writing) in routine, acute and emotionally challenging contexts, with patients, carers and healthcare teams. Candidates (n = 43), non-UK trained volunteers applying to the UK Foundation Programme, were provided with relevant station information prior to the exam.

The criteria for passing the test included achieving the pass score and passing 10 or more of the 14 stations. Of the 43 candidates, nine failed on the station criteria. Two failed the pass score and also the station criteria. The Cronbach's alpha coefficient was 0.866.

This pilot tested ‘proof of concept’ of a new domain-based communication assessment for non-UK trained doctors.

The test would enable employers and regulators to verify communication competence and safety in clinical contexts, independent of clinical knowledge, for doctors who trained in a language different from that of the host country.

The Double Life of Duke of Somerset v Cookson, or a Legal Excavation of the Corbridge Lanx

Duke of Somerset v Cookson (1735) occupies an important place in English legal history as a leading authority for Chancery jurisdiction to order specific delivery of movable property where an award of damages would be inadequate. The property at issue was the Corbridge lanx, now in the British Museum, but then claimed as treasure trove by the duke of Somerset as lord of the manor of Corbridge. This paper re-examines Cookson as the first reported English decision relating to treasure trove, and uses later treasure trove claims by the duke of Somerset's successors to the manor of Corbridge, the dukes of Northumberland, to shed fresh light on the 1735 decision and on the development of treasure trove practice from the eighteenth century onwards.

Developing Entrepreneurial Skills in Pharmacy Students

Objective. To create, implement, and evaluate a workshop that teaches undergraduate pharmacy
students about entrepreneurship.
Design. Workshops with 3 hours contact time and 2 hours self-study time were developed for final-year
students. Faculty members and students evaluated peer assessment, peer development,
communication, critical evaluation, creative thinking, problem solving, and numeracy skills, as well
as topic understanding. Student evaluation of the workshops was done largely via a self-administered,
9-question questionnaire.
Assessment. One hundred thirty-four students completed the workshops. The mean score was 50.9
out of 65. Scores ranged from 45.9 to 54.1. The questionnaire had a response rate of 100%. Many
students agreed that workshops about entrepreneurship were a useful teaching method. Additionally,
they agreed that key skills were fostered.
Conclusion. Workshops effectively delivered course content about entrepreneurship and helped
develop relevant skills. This work suggests students value a program that includes instruction on
entrepreneurship.

An international comparison of legal frameworks for supported and substitute decision-making in mental health services

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person’s wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past thirty years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice.