Research in the Health Professions Education Unit

Title: "From the sticky floor to the glass ceiling and everything in between: A qualitative review focusing on gender inequalities in clinical academic careers"
Timeframe: 2019-21
Funder: NIHR / Wellcome/ CRUK joint funding.
Contact for more information: Professor Gabrielle Finn

Please visit our dedicated web page for this study for full details.

Title: Exploring, understanding and evaluating experiences of Fitness to Practise at the General Dental Council
Timeframe: 2020-22
Funder: General Dental Council
Contact for more information: Professor Gabrielle Finn and Dr Paul Crampton

Summary

The aim of the project is to strengthen and improve Fitness to Practise (FtP) processes, and develop prevention strategies, by understanding the experiences of those who are participants in the FtP process. It will examine the experiences of informants, witnesses, registrants and other stakeholders to ascertain including their needs for support and how guiding principles are applied.

Title: A programme of work analysing the University Clinical Aptitude Test (UCAT)
Timeframe: Ongoing
Funder: UCAT Board
Contact for more details: Dr Paul Tiffin, Dr Lewis Paton

The UCAT is a selection assessment required for entry to undergraduate medicine to the majority of UK medical schools. This programme of quantitative work seeks to generate evidence regarding the properties of the UCAT and how scores from the assessment relate to outcomes of interest. These include performance at knowledge based exams and clinical simulations, as well as any professionalism issues. This work is providing an evidence base for medical selection. This is vital to ensure that selection assessments are used in a way which is fair and helps choose those most suited to a medical career, whilst avoiding negative impacts on the recruitment of underrepresented groups to the profession (i.e. widening access). In order to gain this evidence we apply psychometric and epidemiological statistical methods to analyse national cohort data, often from the UK Medical Education Database.

Our previous work has focussed on whether scores from the UCAT predict undergraduate outcomes, such as examination scores, and how UCAT scores relate to other metrics used in selection, such as A-level performance, as well as sociodemographic characteristics. Our current work includes analysing whether UCAT scores can predict performance later into postgraduate training, and also what role the UCAT situational judgement test should optimally play in medical selection.

Outputs

Predictive validity of the UKCAT for medical undergraduate performance: a national prospective cohort study. Tiffin, P. A., Mwandigha, L. M., Paton, L. W., Hesselgreaves, H., McLachlan, J. C., Finn, G. M. and Kasim, A. S. BMC Medicine, 2016:14;1-19

Predictors of Fitness to Practise Declarations in UK Medical Undergraduates. Paton, L. W., Tiffin, P. A., Smith, D., Dowell, J. S. and Mwandigha, L. M. BMC Medical Education, 2018:18.

What is the effect of secondary (high) schooling on subsequent medical school performance? A national, UK-based, cohort study. Mwandigha, L. M., Tiffin, P. A., Paton, L. W., Kasim, A. S and Boehnke, J. R. BMJ Open, 2018:8;e020291

The ability of ‘non-cognitive’ traits to predict undergraduate performance in medical schools: a national linkage study, Finn, G. M., Mwandigha, L. M., Paton, L. W and Tiffin, P. A. BMC Medical Education 2018:18

Artificial or intelligent? Machine learning and medical selection: possibilities and risks. Tiffin, P.A and Paton, L.W. MedEdPublish, 2018:7;4.

Does ‘online confidence’ predict application success and later academic performance in medical school? A UK-based national cohort study. Tiffin, P.A and Paton, L.W. BMJ Open, 2019:9;e034437

Title: Enhancing selection of the healthcare workforce: a programme of psychometric epidemiology
Timeframe: 2016 - 2021
Funder: National Institute for Health Research
Contact for more information: Dr Paul Tiffin

The purpose of this research was to:

1. To understand how me might improve the selection of UK doctors by analysing information from the UK Medical Education Database (UKMED)

2. To develop the use of Situational Judgment Tests to select staff into Mental Health Services

This fellowship funded a programme looking at selection into healthcare. Specifically we used data from the UKMED, which is a large repository containing information on all UK doctors who entered medical school in 2007, join training schemes from 2012. By conducting data analysis we were able to say what factors at selection were likely to be associated with certain desirable, or undesirable, outcomes later on in a doctor’s career. For example, we looked at predictors related to future fitness to practice issues, and continue with this component of the work. 

A separate strand was focussed on understanding how situational judgement tests (written tests which portray scenarios which challenge professionalism) could be used to improve staff selection for mental health services.

Outputs

Morgan, LJ, Finn GM & Tiffin PA (2021- Accepted). Are efforts to recruit to psychiatry closing the stable door after the horse has bolted? Knowledge and attitudes towards a career in psychiatry amongst secondary (high) school students: A UK-based cross-sectional survey. The Journal of Mental Health. (In press).

Tiffin PA & Paton LW. 2020. Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study. The Postgraduate Medical Journal, Online advance version postgradmedj-2020-137913

Aylott L, Tiffin PA, Brown S. & Finn GM. 2020. Great expectations: Views and perceptions of professionalism amongst mental health services staff, patients and carers. Journal of Mental Health, Online advance version doi.org/10.1080/09638237.2020.1818195

Webster ES, Paton LW, Crampton PES & Tiffin, PA. 2020. Situational judgement test validity for selection: a systematic review and meta-analysis. Medical Education, 54(10), 888-902.

Tiffin PA, Paton LW, O'Mara D, et al. 2020. Situational judgement tests for selection: Traditional vs construct-driven approaches. Medical Education, 54(2), 105-15.

Tiffin PA, Paton LW. 2020. When I say … emotional intelligence. Medical Education, 54(7), 598-599.

Aslet M, Paton LW, Gale T & Tiffin, PA. 2020. Evaluating the recruitment process into UK anaesthesia core training: a national data linkage study of doctors' performance at selection and subsequent postgraduate training. The Postgraduate Medical Journal 2020, 96(1131), 14-20.

Tiffin PA, Paton LW. 2019. Does ‘online confidence’ predict application success and later academic performance in medical school? A UK-based national cohort study. BMJ Open, 9(12), e034437.

Aylott LME, Tiffin PA, Saad M, et al. 2019. Defining professionalism for mental health services: a rapid systematic review. Journal of Mental Health, 28(5), 546-65.

Tiffin PA, Paton LW. 2018. Artificial or intelligent? Machine learning and medical selection: possibilities and risks. MedEdPublish 7, [4], 35.

Tiffin PA, Orr J, Paton LW, et al. 2018. UK nationals who received their medical degrees abroad: selection into, and subsequent performance in postgraduate training: a national data linkage study. BMJ Open,8(7), e023060.

Tiffin PA, Alexander K, Cleland J. 2018. When I say ... fairness in selection. Medical Education, 52(12), 1225-1227.

Smith DT, Tiffin PA. 2018. Evaluating the validity of the selection measures used for the UK’s foundation medical training programme: a national cohort study. BMJ Open, 8(7), e021918.

Patterson F, Tiffin PA, Lopes S, et al. 2018. Unpacking the dark variance of differential attainment on examinations in overseas graduates. Medical Education 2018, 52(7), 736-46.

Paton LW, Tiffin PA, Smith D, et al. 2018. Predictors of fitness to practise declarations in UK medical undergraduates. BMC Medical Education, 18(1), 68.

Mwandigha LM, Tiffin PA, Paton LW, et al. 2018. What is the effect of secondary (high) schooling on subsequent medical school performance? A national, UK-based, cohort study. BMJ Open, 8(5), e020291.

Finn GM, Mwandigha L, Paton LW & Tiffin PA. 2018. The ability of 'non-cognitive' traits to predict undergraduate performance in medical schools: a national linkage study. BMC Medical Education,18(1), 93.

Fielding S, Tiffin PA, Greatrix R, et al. 2018. Do changing medical admissions practices in the UK impact on who is admitted? An interrupted time series analysis. BMJ Open, 8(10), e023274.

Tiffin PA, Paton LW, Mwandigha LM, et al. 2017. Predicting fitness to practise events in international medical graduates who registered as UK doctors via the Professional and Linguistic Assessments Board (PLAB) system: a national cohort study. BMC Medicine, 15(1), 66.

Tiffin PA*, Mwandigha LM, Paton LW, et al. 2016. Predictive validity of the UKCAT for medical school undergraduate performance: a national prospective cohort study. BMC Medicine, 14(1), 140. 

Title: What is the impact of, and interplay between, social & mainstream media on global public health communication during a pandemic?
Timeframe: 2020-2024
Funder: Hull York Medical School
Contact for more information: Dr Kishan Rees

Brief summary:

This project seeks to explore what impact the interplay between social and mainstream media has on the mass communication of public health messaging during a pandemic. What elements help a public health response and what elements hinder it. What are the salient points of what went well? What aspects need further consideration and refinement? It is hoped that this thesis will contribute to the literature, so that when it comes to communicating the public health issues pertaining to the next pandemic, healthcare professionals will be in a better place to utilise the tools available for mass communication and members of the public will be in a better position to comprehend, assimilate and apply such information so they can make decisions that are in their best interests.

Title of Project: An Appraisal of UK Non-Medical Prescribing (NMP) Programmes and their Role in producing high-level prescribers
Timeframe: 2019-22
Contact: Usmaan Omer

Summary

This study aims to utilise a holistic range of guidelines, national and international, to define the qualities of a good prescriber. Subsequently, this information will be used to investigate and appraise the teaching approaches implemented by non-medical prescribing programmes in order to cultivate these qualities. This will be achieved through mapping curriculum documents to prescribing guidelines, telephonically interviewing Non-Medical Prescribing programme directors and Designated Medical Practitioners (DMPs). After this, think-aloud prescribing practice exercises will be conducted with NMP students using clinical vignettes.

Outputs

Omer, U., Danopoulos, E., Veysey, M., Crampton, P., & Finn, G. (2020). A Rapid Review of Prescribing Education Interventions. Medical Science Educator, 1-17.

Omer, U., Veysey, M., Crampton, P., & Finn, G. (2021). What makes a model prescriber? A documentary analysis. Medical Teacher, 43(2), 198-207. 

Title: Performing Identity within Longitudinal Integrated Clerkships
Timeframe: 2018-2022
Funder: Hull York Medical School
Contact for more information: Dr Megan Brown

Brief summary 

This international, longitudinal qualitative programme of study is concerned with investigating how medical students construct and perform medical professional identities during different longitudinal clinical education programmes worldwide. Through expanding what is known in regard to identity development and the impact of longitudinal placements, we hope this research will assist educators and educational leaders in developing pedagogy which effectively supports identity development. 

Outputs/publications/conferences

Brown, M.E., Whybrow, P., Kirwan, G. and Finn, G.M., 2021. Professional Identity Formation within Longitudinal Integrated Clerkships: A Scoping Review. Medical Education.

Brown, M.E., Finn, G.M., 2021. When I say... socialisation. Medical Education.

Brown, M.E., Anderson, K. and Finn, G.M., 2019. A narrative literature review considering the development and implementation of Longitudinal Integrated Clerkships, including a practical guide for application. Journal of medical education and curricular development, 6, p.2382120519849409.

Brown, M.E., Crampton, P.E., Anderson, K. and Finn, G.M., 2020. Not all who wander are lost: evaluation of the Hull York medical school longitudinal integrated clerkship. Education for Primary Care, pp.1-9.

Title: The use and hidden curriculum of occupational and black humour in medical education.
Timeframe: 2018-2020
Funder: Hull York Medical School
Contact for more details: Professor Gabrielle Finn, Angelique Duenas and Karen Kirkness (PhD students)

The purpose of this project is to investigate the use of occupational humour, including black humour, and  its associated hidden curriculum, within medical education.

Humour in the workplace is common, especially in challenging environments. Often the use of humour can be regarded as a way to stress defuse, or build camaraderie. Issues arise when humour is misconstrued, unprofessional or offensive.

This study explores the use of humour in undergraduate, clinical and dissecting room environments, aiming to establish an understanding of the context of and hidden curriculum associated with its use.

The study uses an international survey of academics and clinicians, as well as focus groups with staff and students in key clinical and anatomical environments where humour may be rife.

Outputs

Should Black Humor Be Put to Death? Examining Student and Staff Views on Black Humor in Anatomy Labs
Poster presentation at the American Association of Anatomists, Orlando, April 2019. 

Title: An assessment of Gateway Year programmes in the UK
Start date: October 2018 (PhD)
Funder: Hull York Medical School
Supervisors: Professor Gabrielle Finn and Dr Paul Tiffin
Contact for further details: Angelique Dueñas

This study aims to provide an assessment of the current state of Gateway programmes across the nation to help understand best practices for success of Gateway Year programmes.

In the past few years there has been a rapid increase in the number of Gateway to Medicine programmes across the UK, rising from only 7 recognized programmes in 2017 to a total of 17 planned to launch in 2019. However, there is currently very limited research about academic progression of Gateway Year students through their medical education. This study aims to provide an assessment of the current state of Gateway Year programmes across the nation to help understand best practices for success of Gateway Year programmes.

Title: Defining and measuring professionalism in Mental Health Staff: A mixed methods approach
Award: PhD
Timeframe: 2016-2019
Funder: Hull York Medical School scholarship
Supervisors: Professor Gabrielle Finn and Dr Paul Tiffin
Contact for further details: Lauren Aylott

Lauren’s PhD aims to develop a situational judgement test that will assess practitioners’ knowledge of professionalism within a mental health service context. This will support a values-based recruitment approach; recruiting staff with the right values, as well as knowledge and skills for the role.

Situational Judgement tests have been used for many years to support the recruitment of staff. A situational judgement test in this context, will present test-takers with job-related hypothetical scenarios, to which individuals will need to select the most appropriate behaviour out of a list of potential response options.

Publications

Aylott, L.M., Tiffin, P.A., Saad, M., Llewellyn, A.R. and Finn, G.M., 2018. Defining professionalism for mental health services: a rapid systematic review. Journal of Mental Health, pp.1-18.

Title: Evaluation of the NHS GP Induction and Refresher Scheme Assessments
Timeframe: March-June 2019
Funder: Health Education England (HEE)

The NHS GP Induction and Refresher Scheme provides a safe, supported and direct route for qualified GPs to join or return to NHS general practice. It is designed for GPs who have previously been on the GMC Register and NHS England’s Medical Performers List (NMPL) and would like to return to general practice after a career break, raising a family or time spent working abroad. The scheme also supports the safe introduction of overseas GPs who have qualified outside the UK and have no previous NHS experience.

A revised scheme was launched in March 2015 to enable doctors who hold a recognised qualification in general practice and GMC registration to begin or return to practice as GP. It is aimed at GPs who have qualified overseas and not worked in the NHS before (induction) and those who have worked as a NHS GP before but been away for over two years or more (refresher). Co-ordinated through the GP National Recruitment Office (GPNRO), doctors have a single standardised entry point. This project will look at a number of questions concerning the entry requirements (e.g. does the programme avoid “setting up doctors to fail” in complex environments?), outcome appraisal (e.g. is the current programme of assessment fit for purpose?), and completion rates (e.g. are the current standards appropriate to ensure patient safety and patient-centred practice?) of the scheme.

To ensure patient safety and simultaneously minimise the risk of failing doctors who are competent, it is of paramount importance to have an assessment system that is fit for the intended purpose, facilitates feedback, informs future learning, and allows for setting standards that helps us to distinguish between competent and less competent candidates. This project focuses on these questions for the NHS GP Induction and Refresher Scheme.

Title: Implementing a longitudinal integrated clerkship; identifying key barriers and enablers
Timeframe: 1 year until September 2019
Funder: Hull York Medical School / MSc dissertation
Contact for further details: Dr Kevin Anderson

This is a qualitative research study analysing the process of implementing a longitudinal clerkship (LIC) at a medical school, particularly the key barriers and enablers.

LICs are a relatively new type of medical student placement that proponents suggest can deliver a transformative approach to clinical education using continuity and the development of relationships between students, patients and physicians to underpin (and ultimately optimise) the student experience. There is a relative paucity of evidence about the challenges and enablers encountered during the implementation an LIC as part of a medical school curriculum. This project will seek to address this gap through a thematic analysis of semi-structured interviews conducted with medical educators in a variety of medical schools around the world.   

Title: The development, implementation, and evaluation of an interprofessional intervention for healthcare promotion: Repurposing the Teddy Bear Hospital
Timeframe: 2018-2020
Funder: Health Education England
Contact for more details: Professor Gabrielle Finn and Dr Jimmie Leppink

Teddy Bear Hospital (TBH) is an initiative founded by the European Medical Students’ Association (EMSA) intended to help 3-12 year-olds to lose their fear towards doctors and hospital environments. This project enables healthcare students from different programmes to work together to develop TBH events focused on health promotion. 

Through this cross-university collaboration, we bring together students from the Medicine, Nursing (child, adult, disability and mental health), Paramedic and Physician Associate cohorts to develop health promotion events for children, while simultaneously researching how such activities help these aspiring healthcare professions cohorts to develop their interprofessional relationships.

The research element focuses on exploring:

• Barriers and promoters to participating in interprofessional education (IPE)
• Lessons learned on: IPE collaboration and other professions, working with a paediatric audience, leadership and team-working, perceptions of outreach initiatives.
• Ideas for future development and what will be taken forward into their future clinical practice.

Collaborators

• Professor Julie Jomeen
• Professor Martin Veysey
• Kate Bowers, Lecturer / Academic Lead for Nursing Programmes, Faculty of Health Sciences, University of Hull