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Interested in building experience in online engagement and publishing through interaction with Editors-in-Chief, the e-Council and the Editorial Office?

Consider applying for the e-Editor Intern position!

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Conversation Kickstarter for The Clinical Teacher (#ClinTeachJ): Bullying


In the April issue of The Clinical Teacher (#ClinTeachJ, linked here), Katie Cresswell and colleagues tackle an important topic; bullying in graduate medical education. Their article, entitled Bullying workshops for obstetric trainees: a way forward, describes important work done in the National Health Service within the United Kingdom in Obstetrics & Gynecology training.

Bullying as part of education or of training is certainly not unique to Obstetrics & Gynecology in the UK system, nor even to medicine. Its ill effects have been well documented (including excellent references in the Cresswell article), and yet it is still pervasive.

Questions to consider:

  • Do you have alternative views of the role of bullying in education and training?
  • What are some examples you can think of from your own context?
  • Is this systemic, or the result of a ‘few bad actors’?
  • Would implementing a workshop such as that described in the article be feasible in your situation?

Reference: Cresswell, K., Sivashanmugarajan, V., Lodhi, W. and Yoong, W. (2015), Bullying workshops for obstetric trainees: a way forward. Clin Teach, 12: 83–87. doi:10.1111/tct.12261

Conversation Kickstarter | Feedback and the learner


by Teresa Chan, MD, FRCPC
e-Editor intern, Assistant Professor, McMaster University

In this month’s upcoming issue of The Clinical Teacher, David Boud writes a commissioned paper that provides us with helpful tips and hints regarding feedback.  This article is most definitely a ‘go to’ resource for any health professional who teaches in the clinical setting.

As he highlights in the article,”… [f]eedback in clinical settings, must be characterised
not solely in terms of inputs, but also by the effects that result.”  Particularly, this concept hit home for me.  You see, for the past few years I’ve been hard at work at my institution working with our residency education program to redesign workplace based assessment to emphasize feedback.  This has resulted in the McMaster Modular Assessment Program, and I must say, even after all of the literature I’ve read, Dr. Boud’s paper really synthesized and summarized some really pragmatic tips that I will be taking to the bedside.

As a learner, I was always the pesky learner that asked for feedback… and I recall being quite aggressive in asking for specific ways to improve my burgeoning practice.  Now, as a junior clinician educator that is interested in assessment and feedback, I have lived my life with trying to figure out how to best design a system that creates the opportunities for residents to do the same.

At times, I worry that by being too much of an educational designer, I am removing the agency from the learner, and decreasing the impetus for them to self-direct this feedback. Recently, I have read the book by Stone & Heen which emphasizes the key skill of receiving feedback well (Thanks for the Feedback: The Science and Art of Receiving Feedback Well).

And so, I am wondering if I might engage The Clinical Teacher audience in a discussion around the idea of feedback using these three questions:

  • Q1: Are we ‘babying’ learners these days too much by creating systems that encourage feedback?
  • Q2: Or does the system need to be there to provide a scaffold for learners so that they might one day more fully participate in the feedback experience?
  • Q3: Ultimately, what is the role of the adult health professions learner in the feedback process?

Please drop a line below to reply to these questions (and be sure to mark which question you’re answering using Q1/Q2/Q3).  Feel free to tweet around this using the hashtag #ClinTeach.

Clinical Teacher | Bullying workshops for obstetric trainees: a way forward

by Katie Cresswell, Viswapriya Sivashanmugarajan, Wasim Lodhi and Wai Yoong

Link to article here.


In sector-wide surveys, trainees in obstetrics and gynaecology have consistently reported the experience of being undermined in the workplace. Bullying has serious implications within the UK’s National Health Service (NHS), for both the individual experiencing it and the wider system.


Obstetrics and gynaecology is a high-pressure specialty: the workload is intense, staffing is often suboptimal and litigation levels are high. Obstetrics alone accounted for 50 per cent of litigation claims in the NHS in 2012. This ‘cocktail’, when combined with the target-based management style common in the current financial climate, easily lends itself to a culture of bullying.


In order to manage this problem a workshop was developed with the initial aim of raising awareness, entitled ‘Undermining and Harassment: A Practical Workshop for Trainees’. A typical workshop comprises the following interlinking topics relevant to bullying: (1) what is bullying (interactive session); (2) case scenarios (based on real events) and discussion (audiovisual clips); (3) how bullying affects patient safety (presentation); (4) how to support senior staff displaying bullying behaviour (interactive session); (5) how to be assertive without being aggressive (role-play); and (6) practical tips, including the ‘Survivors’ Guide to Bullying’ (interactive session).


These workshops were designed as practical tools to raise awareness of workplace harassment, and not as a research project to assess the longitudinal impact of the workshops. Feedback from six such workshops as well as informal focus groups from trainees who had previously attended indicated that the subject was useful and necessary.

Bullying has serious implications within the UK’s National Health Service


The aim of the workshops was to raise awareness of bullying and undermining in the workplace, and the serious implications they can have for the individual, patients and the NHS as a whole. This will enable a positive culture shift and encourage health care professionals to think before they speak or act.

DOI: 10.1111/tct.12261


Clinical Teacher | Learning opportunities in ‘student assistantships’

by Bryan Burford, Edward Ellis, Alyson Williamson, Ian Forest and Gillian Vance

Link to article here.


In order to gain experience of the skills required when they begin practice, all final-year medical students in the UK undertake a ‘student assistantship’, working alongside first-year postgraduate doctors. In this study, we examined the learning opportunities open to students in one locality during two periods of assistantship: one in medicine; one in surgery.


Final-year students and their supervisors completed online questionnaires. The students’ questionnaire explored general perceptions of the placement, and whether 15 potential learning opportunities (identified as ‘desk-’ or ‘patient-oriented’) had been ‘taken’, ‘missed’ or were ‘not available’. The supervisors’ questionnaire explored their perceptions of students’ learning during the assistantship.


Overall, 86 student questionnaires and 17 supervisor questionnaires were returned (response rates of 57 and 63%, respectively). Students reported more desk-based learning opportunities, of which more were taken up, than patient-oriented learning opportunities. Surgical placements were associated with more ‘missed’ opportunities than medical placements. Across all tasks, many students felt that some learning opportunities were not present in their assistantship. By contrast, supervisors felt students ‘made the most’ of assistantships. Students’ overall perceptions of the assistantship were positively related to the level of experience that they had attained (r = 0.40–0.54).

Surgical placements were associated with more ‘missed’ opportunities than medical placements


The assistantship fulfils its aims for many students, but individual experience gained varies considerably. Some opportunities are not being taken, with ‘patient-oriented’ opportunities more likely to be missed, whereas others are not available during placements. Supervisors may overestimate the educational value of the assistantship, with implications for its management and delivery.

DOI: 10.1111/tct.12269


Clinical Teacher | A prolonged assistantship for final-year students

by Elewys Lightman, Sarah Kingdon and Michael Nelson

Link to article here


The transition from medical student to junior doctor is challenging, therefore adequate preparation during medical school is crucial for a smooth transition. Tomorrow’s Doctors expects students to undertake a student assistantship, separate from the local shadowing period prior to commencing employment. Sheffield Medical School initiated a 6–week assistantship within the Yorkshire and Humber deanery. This mixed-methodology study explores this experience from the perspective of final-year medical students.


Final-year medical students responded to a questionnaire about anxieties surrounding their forthcoming foundation year 1 (FY1). Students were purposefully sampled and semi-structured interviews (SSIs) were conducted, with 20 participants exploring their experience of the assistantship. Interviews were transcribed verbatim and thematic analysis was carried out.


The questionnaire results highlighted that most students felt anxious about becoming a FY1 doctor, and subsequent interviews demonstrate that the assistantship mostly met with students’ expectations. Major themes regarding their anxieties included the value of building professional relationships, familiarisation with the work environment, level of supervision and the value of targeted teaching.

Tomorrow’s Doctors expects students to undertake a student assistantship


Student assistantships clearly improve preparedness and confidence in the transition to FY1 by enabling supervised, stepwise responsibility. In the future a nationally cohesive programme should be created for shadowing and assistantships matched with students’ prospective jobs.

DOI: 10.1111/tct.12272

Featured Article | Portrait of a Rural Health Graduate; exploring alternate health spaces.

Summary by Susan Law
This paper describes some of the barriers, challenges and support that a student in South Africa experienced on his journey to become a Health Professional. His journey was more challenging than many but South Africa is not alone in having barriers to professional education for those from non-traditional backgrounds or from rural/remote areas. Some of the issues described – schools that don’t offer the relevant courses; teachers who don’t consider career options and low parental income were mentioned to me recently by a Dundee student from a rural area.
  • we know that recruiting from rural backgrounds is more likely to produce practitioners who return to rural areas  (Curran & Rourke (2004)
  • we believe that patients need health professionals from a wide range of backgrounds and that we need to encourage widening participation and the recruitment of students from non-traditional backgrounds.
Where to next?
  • new models of learning
    • longitudinal clerkships have been tried in the USA, Australia and Canada (Biden and Wilson (2012), Norris et al (2009))
      • they produce students of the same standard as traditional curricula
      • the students seem to be more patient centred
      • they offer supportive one on one tutor/student relationships
At a recent meeting with medical students we discussed some of the issues they perceive to be relevant in developing a longitudinal clerkship and some of the suggested solutions they offered to the recruitment crisis, what do you think?
  •      political interventions
    • good rural infrastructure (Internet access)
    • jobs for partners
    • schools for children
    • housing
    • fee waivers
    • reward higher education facilities that promote widening participation in health professional education
  • university/college issues
    • investment in student support
    • investment in widening participation
    • willingness to explore new options
    • new models of learning
Biden H & Wilson I (2012) Rural placements are effective for teaching medicine in Australia: Evaluation of a cohort of students studying in rural placements Rural and Remote Health (accessed
Curran V, Rourke J. (2004)The role of medical education in the recruitment and retention of rural physicians. Med Teach 26: 265-72 (PDF accessible on line)
Norris T el al (2009) Longitudinal Integrated Clerkships for Medical Students: An innovation adopted by Medical Schools in Australia, Canada, South Africa and the United States Academic Medicine 84: 7: 902-907

Excellent Medical Education Programme winners announced

The Association for the Study of Medical Education (ASME) and the General Medical Council of the United Kingdom have selected three winners for their Excellent Medical Education Programme. ASME is based in the UK and along with the publisher John Wiley & Sons Ltd. produce the two journals, Medical Education and The Clinical Teacher. For more information about the Excellent Medical Education Programme and other awards available through ASME, visit the ASME site at or click here. The press release follows.


Excellent Medical Education Programme winners announced

The three winners of the joint Association for the Study of Medical Education and General Medical Council Excellent Medical Education Programme have been announced, with each receiving £5,000 in funding.

The Excellent Medical Education Programme is a set of national awards established by ASME and the GMC in order to fund high quality medical education research, development and innovation. This was in response to recognition of the need for further research-based evidence related to medical education and training.

Applications were invited relating to the topics Innovation in Education, Sustaining Excellent Education and Developing and Supporting Educators.

  • Continuing Professional Development Winner

Mandy Moffat, University of Aberdeen     

Submission title – Educational Development in Context: Developing a Regional Community of Practice (CoP) in Psychiatry

Mandy says: “Together with my colleagues, Dr Isobel Cameron and Dr Daniel Bennett, we are delighted to have been successful in winning the ASME and GMC Excellent Medical Education Programme funding bid. We plan to explore and analyse how our activities around a summer educational CPD event influence the wider community of medical teachers across a large geographical area (Aberdeen, Elgin and Inverness). With the funding, we can arrange more planning meetings with our colleagues in Elgin and Inverness, provide a summer studentship to one of our MBChB students to carry out key data collection and initial analysis, and explore and examine our approaches to educational CPD in much more detail, going beyond simple evaluation.”

  • Postgraduate Winner

Jeremy Brown, Edge Hill University              

Submission title – An investigation into Specialty Trainee Engagement with E-learning in Health Education North West

Jeremy says: “Our Postgraduate project, to be delivered in the next 12 months, will provide an assessment of the e-learning resources that are being utilised and valued by specialist trainee doctors in Health Education North West. It is important that those managing doctors on Specialist Training Programmes are provided with guidance on e-learning packages and whether they are likely to be beneficial for them. There is a massive increase in technology enhanced learning and it can be argued that research is not keeping up with the pace needed to provide the necessary evidence on its impact on medical education practice.”

Jeremy will be working on the project with Prof Nigel J Shaw, Evidence-based Practice Research Centre, Edge Hill University; Dr Stevie Agius, Health Education North West, and

Prof Jacky Hayden, Dean of Postgraduate Medical Studies, Health Education North West.

  • Undergraduate Winner

Dr Janet Lefroy, Keele University School of Medicine                  

Submission title – Authentic Undergraduate Placements in GP: A Recruiting Force for Generalists?

Dr Lefroy says: “We will be extending an existing study of the transition from student to doctor to explore a) what underpins the choice of speciality for training of Foundation2 doctors from Keele and other medical schools, and b) the influence of undergraduate curricula, in particular exposure to specialities, including general practice, on the doctor’s thinking about career options. The Medical Education Research Group at Keele is grateful to ASME and GMC for funding the award and we are excited to be embarking on this study in autumn 2015.”

Dr Lefroy will be working on the study with Bob McKinley, Ruth Kinston, Simon Gay, Stu McBain and Sarah Yardley.

Nicky Pender, ASME chief executive, says: “We have been impressed with the standard of submissions for the awards and wish all three winners luck with their projects. We very much look forward to seeing the results.”

Dr Vicky Osgood, Director of Education and Standards at the GMC, said: “We value the Excellent Medical Education Programme and support all manner of research, development and innovation in this field. It was pleasing to see so many entries for the programme and the winners are fully deserving of their prizes. This programme will help to continue to improve medical education and training through innovative research projects. We hope this will inspire others in future to take part in such a valuable initiative.”

May 2015 Really Good Stuff | A Journal Club Review – Tips for promoting professional identity development

e-Editor Intern’s note:  The following is a scholarly review of several articles found in our Really Good Stuff section of this month’s edition.  We thank Carey & Megan for their thoughtful review. – TC

By Carey Mather & Megan Quentin-Baxter

Four short papers appearing in the May issue of Medical Education focus on a constructivist learning approach and personal accountability to develop appropriate professional behaviours and identity. The first three are relatively low cost interventions using existing tools or infrastructure in new, authentic ways, minimising the impact on staff, and explicitly recognising the challenges of an overcrowded curricula. The fourth builds on establishing a safe environment for ‘raising concerns’. The tools provide students with mechanisms for bridging between theory and experiential learning environments, and promoting the development of ‘agency’.(1)

‘Off to a good start’(2) describes medical student orientation to “highlight the central role of physician-patient relationship on the first morning of the first day” and teasing out the reasons why students chose this profession. This sharing forms a platform for an on-going relationship with the programme educators and peers and promotes “facilitating transition into the medical profession”. The researchers claimed that the “profoundly moving stories that emerge not only help each student calibrate their individual moral compass … also serve as an important team building experience”. One student said that it “set an inspirational tone” and the researchers found “professional identity that embraces inquisitive and altruistic professional behaviour” consistent with theories elsewhere.(3)

‘Using Twitter to teach problem based learning’(4) harnessed an emerging social media technology as a useful adjunct for a crowded curricula to “use an innovative approach to optimise the method in which we delivered PBL tutorials.” This innovation minimised impact on student and staff time because participants could post or review the microblogs asynchronously outside scheduled tutorials. It enabled connectivity within the group even though they only met intermittently.(5) Identifying the learning objectives and answering simple questions as they arose enabled more complex interactions during tutorials. Despite staff using the same ‘tutor’ account students indicated they developed rapport with staff members. This strategy also promoted a learner-centred approach that is reshaping pedagogy.(6)

The ‘Professional competencies toolkit: Teaching reflection with flash cards’(7) project sent students into clinical experience every two weeks with at least one of 28 flash cards defining a topic (such as ‘the invisible patient’) and tasks and tips for dealing with it to promote concepts that define habitual professionalism. The flash card/aide memoire provided a specific hook to remind students to collect evidence to facilitate subsequent reflection. This process encouraged to students to bring “their story back to the group” for further discussion in small group settings. The authors claim that encouraging students to focus on “manageable learning “bites” or ”one or two basic elements” promoted a level of reflection leading to “deep understanding of the importance and complexity of the broader issue.” reflecting the early stages of theoretical concepts of Fink’s ‘significant learning’.(8)

Concerns about raising concerns’(9) described an environment based on (10) responding to the UK’s Francis Report (11) where dental students were encouraged to “explore their understanding and beliefs regarding professional behaviours” in workshops, annual learning agreements, lectures and final year seminars. New policies and practices (many escalating externally to the school) were put in place to ensure “visibly fair and effective” actions arising from student’s views. The authors observed that students raised “significantly” far more concerns about “themselves, colleagues and staff” than were expected.

In all the use of narrative and communication inform professional identity and promote rapport development with teachers, students or patients. Collaborative, interactive team-building strategies were used to model and explore the central themes, with a common outcome of increased collaboration or connectivity between students, staff or patients. Communication processes were orientated towards relationship-building and increase of rapport to support patient-centred care and habituate professional behaviours.

These approaches give students an opportunity to contribute through articulation of self and their experiences. The student role is elevated to co-creator of knowledge, co-owner of responsibility, and students provided with real opportunities to contribute to patient safety and care.

Collectively these novel approaches could be tailored to other healthcare programmes to foster professional behaviours and student accountability. It would be interesting to hear from institutions using similar or a mixture of methods to promote professional identity development of students.


  1. Billett S. Relational interdependence between social and individual agency in work and working life. Mind, Culture, and Activity 2006;13(1):53-69.
  2. Danoff A, Garabedian M, Harnik V, Rosenthal M. Off to a good start. Medical Education 2015;49(5):514.
  3. Stern DT. Measuring Medical Professionalism. New York: Oxford University Press 2006.
  4. Lasker R, Vicneswararajah N.. Using Twitter to teach problem-based learning. Medical Education 2015;49(5):531.
  5. Kamel Boulos MN, Wheeler S. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and healthcare education. Health Information and Libraries Journal 2007;24(1):2-23.
  6. Caplan W, Myrick F, Smitten J, Kelly W. What a tangled web we weave: How technology is reshaping pedagogy. Nurse Education Today 2014;34(8):1172-4.
  7. Seymour P, Watt M. The professional competencies toolkit: teaching reflection with flash cards. Medical Education 2015;49(5):518.
  8. Fink LD. Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses. Jossey-Bass 2003.
  9. Ellis JS, Bateman H, Thomason JM, Whitworth J. Concerns about raising concerns. Medical Education 2015;49(5):514-5.
  10. Kelly M, O’Flynn S, McLachlan JC, Sawdon MA. The clinical conscientiousness index: a valid tool for exploring professionalism in the clinical undergraduate setting. Academic Medicine 2012;87(9):1218-24.
  11. The Mid Staffordshire NHS Foundation Trust. Public Inquiry Chaired by Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 3 vols. London: Stationery Office 2013.

Portrait of a rural health graduate: exploring alternative learning spaces

By Andrew Ross and Daisy Pillay

Link to article here.


Given that the staffing of rural facilities represents an international challenge, the support, training and development of students of rural origin at institutions of higher learning (IHLs) should be an integral dimension of health care provisioning. International studies have shown these students to be more likely than students of urban origin to return to work in rural areas. However, the crisis in formal school education in some countries, such as South Africa, means that rural students with the capacity to pursue careers in health care are least likely to access the necessary training at an IHL. In addition to challenges of access, throughput is relatively low at IHLs and is determined by a range of learning experiences. Insight into the storied educational experiences of health care professionals (HCPs) of rural origin has the potential to inform the training and development of rural-origin students.


Six HCPs of rural origin were purposively selected. Using a narrative inquiry approach, data were generated from long interviews and a range of arts-based methods to create and reconstruct the storied narratives of the six participants. Codes, categories and themes were developed from the reconstructed stories. Reid’s four-quadrant model of learning theory was used to focus on the learning experiences of one participant.


Alternative learning spaces were identified, which were made available through particular social spaces outwith formal lecture rooms. These offered opportunities for collaboration and for the reconfiguring of the participants’ agency to be, think and act differently. Through the practices enacted in particular learning spaces, relationships of caring, sharing, motivating and mentoring were formed, which contributed to personal, social, academic and professional development and success.


Learning spaces outwith the formal lecture theatre are critical to the acquisition of good clinical skills and knowledge in the development of socially accountable HCPs of rural origin.

Article first published online: 28 APR 2015 | DOI: 10.1111/medu.12676