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Research in the Health Professions Education Unit

Our research is wide ranging across undergraduate and postgraduate health professions education.

Utilising a range of quantitative, qualitative and mixed methods, our key strategic areas of interest and expertise are:

  • Professionalism
    • Including: identity, empathy, inequalities, workplace learning, inclusion, regulation
  • Healthcare workforce
    • Including: selection, widening participation, fitness to practise, social accountability
  • Assessment
    • Including: conscientiousness index, programmatic, standard setting, authentic  

Our current research

Experiences of under-represented and widening participation medical students during their time at medical school

Title: Experiences of under-represented and widening participation medical students during their time at medical school

Timeframe: 2021-ongoing

Contacts: Dr Alison Graham and Dr Jason Boland

Medicine as a profession is increasingly looking to widen the characteristics of those that become doctors to be more reflective of the population as a whole.  Nationally, there has been much focus on widening access (i.e. increasing the number of students from backgrounds of traditionally low participation in higher education) but less focus on the support of these students after they enter university.

This project is investigating the experiences of students from under-represented groups during their time at medical school and exploring whether any additional activities should be in place to support these students during their studies. We are particularly interested in the experiences of students who completed a Gateway Year (as the 1st year of a 6 year MB BS) compared to the experiences of students who directly entered Year 1 of a Medicine programme (5 year MB BS).

By having a deeper understanding of the experiences of students from under-represented/widening participation groups, we hope to better recognise the challenges they face in medical school and identify effective support to empower all students.

Outputs

Poster at York Learning & Teaching conference, March 2022

Invited talk at the National Medical Schools Widening Participation Forum - Teaching, Learning and Student Success sub-group, March 2022

Invited talk at the National Medical Schools Widening Participation Forum Summer Meeting, Birmingham, June 2022

Oral presentation and poster at Horizons in STEM Higher Education Conference, London, June 2022

Discussion paper at the University of Hull 2022 Annual Summer Learning and Teaching Conference, July 2022

Exploring, understanding and evaluating experiences of Fitness to Practise at the General Dental Council

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.

A programme of work analysing the University Clinical Aptitude Test (UCAT)

Title: A programme of work analysing the University Clinical Aptitude Test (UCAT)
Timeframe: Ongoing
Funder: UCAT Board
Contact for more details: Professor 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

Can achievement at medical admissions tests predict future performance in postgraduate clinical assessments? A UK-based national cohort study Paton, L. W., McManus, I. C., Cheung, K. Y. F., Smith, D. T. & Tiffin, P. A. BMJ Open, 2022;12:e056129.

A programme of research to explore, understand and challenge approaches to workplace learning in healthcare settings

Title: A programme of research to explore, understand and challenge approaches to workplace learning in healthcare settings

Timeframe: Ongoing

Contact for more information: Dr Paul Crampton

We seek to enhance and invigorate the ways in education is conducted in the workplace, addressing key workforce, regulatory and health professional education issues. Collectively, the work facilitates in-depth understandings of professionalism, regulatory approaches, methodological designs and educational innovations that lead to a range of implications for individuals, teams and organisations. The core theme of our current research orientates around enhancing practice in the workplace be it undergraduate or postgraduate education, exploring a range of factors such as longitudinal placements, identity, interprofessional learning, empathy, wellbeing and fitness to practise. Recent projects have been exploring questions such as:

  • How can organisations effectively structure clinical placements so that patient safety, excellent education and wellbeing are maintained?
  • How can educators best support learner’s transition integration into the clinical workplace?
  • How can regulators ensure their processes are fair and transparent in making sure their registrants are fit to practise?
  • In what ways can theoretical insights drive improvements in constructing educator-student supervisory relationships in various professions?

Key outputs

Wilkinson, C., Finn, G., & Crampton, P. (2021). Responsibility with a Safety Net: Exploring the Medical Student to Junior Doctor Transition During COVID-19. Medical science educator, 1–9. Advance online publication. https://doi.org/10.1007/s40670-021-01476-8

Crampton, P., Mehdizadeh, L., Page, M., Knight, L. and Griffin, A., (2019). Realist evaluation of UK medical education quality assurance. BMJ open, 9(12).

Stott, J., Haywood, J., & Crampton, P. (2021) Early career doctors' experiences of psychiatry placements: A qualitative study, Medical Teacher, DOI: 10.1080/0142159X.2021.1934425

Knight, L., Crampton, P., McKeown, A., Arora, A., Cliffe, C., O’Keeffe, C., & Griffin, A. (2022). Education for collaboration: the influence of the third space on professional boundaries. London Review of Education, 20(1).

King, O., Davis, C., Clemans, A., Coles, J., Crampton, P., Jacobs, N., McKeown, T., Morphet, J., Seear, K. and Rees, C., 2019. Dignity during work-integrated learning: what does it mean for supervisors and students?. Studies in Higher Education, pp.1-16.

A programme of realist methodology work

Title: A programme of realist methodology work

Timeframe: Ongoing

Contact for more information: Dr Millie Kehoe

Realist methodology is continually gaining popularity and growing interest within the world of Medical Education. It's strength lies within its explanatory power, illustrating the 'how' and 'why' questions that are often left unanswered when we are evaluating complex interventions. We have successfully developed and delivered a number of realist projects that have had substantial impact and change (see below), delivered national and international workshops, and developed papers and book chapters on the methodology. Any interest in this methodology welcome.

Key outputs

Kehoe, A., McLachlan, J., Metcalf, J., Forrest, S., Carter, M., & Illing, J. (2016). Supporting international medical graduates’ transition to their host-country: realist synthesis. Medical Education, 50: 1015–1032.

Illing, J., Corbett, S., Kehoe, A., Carter, M., Hesselgreaves, H. et al. (2018) How does the education and training of health and social care staff transfer to practice and benefit patients? A realist approach. Final Report for Department of Health, July 2018. 

Ellaway, R., Kehoe, A., Illing J. (2020). Critical Realism and Realist Inquiry in Medical Education. Academic Medicine. 95(7):1.

Finn, G., Crampton P., Kehoe, A. et al. (2021). Exploring, understanding and evaluating experiences of Fitness to Practise at the General Dental Council. Second Interim Report.

Kehoe, A. Rothwell, C. & Bluhm, R. (2021). The philosophy of science. In Brown, M.E., Veen, M., Finn, G.M. A Journey Towards Mutual Understanding: Applied Philosophy for Health Professions Education. Book-edited volume. [Springer Publishing House] https://link.springer.com/book/10.1007/978-981-19-1512-3

Enhancing selection of the healthcare workforce: a programme of psychometric epidemiology

Title: Enhancing selection of the healthcare workforce: a programme of psychometric epidemiology
Timeframe: Ongoing
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

Tiffin, P. A., Sanger, E., Smith, D., Troughton, A. & Paton, L. W., Situational judgement test performance and subsequent misconduct in medical students. Medical Education. 2022 (E-pub ahead of print)

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. 

Empathy and patient centred consulting

Title: Empathy and patient centred consulting

Timeframe: Ongoing

Contact for more information: Dr Bill Laughey and Dr Paul Crampton

The Unit has produced several publications in empathy and patient centred consulting in the last five years. Empathy is key to collaborating and co-operating with others. It is the means by which we connect with each other - with family, friends, colleagues, patients. In healthcare, empathy is linked with better satisfaction with the consultation, with improved diagnosis and better health outcomes. Our research has been mainly qualitative and aimed at understanding how students learn empathy and the enablers and barriers to fostering empathy in health professions education. Along the way, we have pioneered a new method for researching empathy and other constructs related to feelings and emotions: love and breakup letter methodology. This portfolio of work has been a HYMS team effort, with multiple HPE researchers interviewing our medical and PA students to understand empathy pedagogy. We have also collaborated with other medical schools in our research, including Durham, Newcastle and Sheffield. We encourage new research in the field, particularly in our MSc and PhD programmes.

Outputs 

Fragkos, K. C., & Crampton, P. E. (2020). The effectiveness of teaching clinical empathy to medical students: a systematic review and meta-analysis of randomized controlled trials. Academic Medicine, 95(6), 947-957.

Laughey, W., Sangvik Grandal, N. and M Finn, G., 2018. Medical communication: the views of simulated patients. Medical education, 52(6), pp.664-676.

Laughey, W.F., Brown, M.E., Dueñas, A.N., Archer, R., Whitwell, M.R., Liu, A. and Finn, G.M., 2021. How medical school alters empathy: student love and break up letters to empathy for patients. Medical education, 55(3), pp.394-403.

Laughey, W.F., Brown, M.E. and Finn, G.M., 2020. ‘I’m sorry to hear that’—Empathy and Empathic Dissonance: the Perspectives of PA Students. Medical science educator, 30(2), pp.955-964.

Laughey, W.F., Brown, M.E., Liu, A., Dueñas, A.N. and Finn, G.M., 2021. Love and breakup letter methodology: A new research technique for medical education. Medical education, 55(7), pp.818-824.

Bizzari, V., Dambha-Miller, H., Laughaey, W.F., Carvalho, C. and Oxford Empathy Programme, 2019. Defining therapeutic empathy: the philosopher’s view. Journal of the Royal Society of Medicine, 112(3), pp.91-95.

Laughey, W.F., Brown, M.E., Palmer, E.G. and Finn, G.M., 2021. When I say… empathic dissonance. Medical education, 55(4), pp.428-429.

Laughey, W., Sangvik Grandal, N., Stockbridge, C. and Finn, G.M., 2019. Twelve tips for teaching empathy using simulated patients. Medical teacher, 41(8), pp.883-887

Diversity in medical education leadership

Title: Diversity in medical education leadership

Timeframe: 2021-2023

Contact: Dr Paul Crampton

The purpose of the study is to understand the lived experiences and perceived barriers in the leadership journey of minority ethnic training programme directors and evaluate whether a new programme was beneficial in helping them achieve their leadership aims. If the programme is successful, one way to raise its profile nationally and secure funding for further development would be if the intervention is shown to be effective using an evidence-based approach. The findings will be used to produce a report to inform developments of the programme. It also provides accountability to take action to reduce discrimination at a higher level. The experiences of participants involved is critical to the sustainability and efforts to reduce discrimination in the workforce.

Outputs

Crampton, P. E., & Afzali, Y. (2021). Professional Identity Formation, Intersectionality and Equity in Medical Education. Medical Education.


Past projects

Evaluation of the NHS GP Induction and Refresher Scheme Assessments

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.

Implementing a longitudinal integrated clerkship; identifying key barriers and enablers

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.   

Gender inequalities in clinical academic careers

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.

The use and hidden curriculum of occupational and black humour in medical education

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.