BackgroundInternationally, there has been a move towards fostering diverse healthcare workforces that are representative of the patient populations they serve. Selection criteria for academic-clinicians often aim to capture skills and attributes that demonstrate both clinical and academic excellence. Currently, it is not known whether the selection criteria for early academic-clinical careers advantage or disadvantage certain ethnic or socioeconomic groups. The UK has a structured route of integrated clinical academic training with entry level training for newly qualified doctors administered through the 'Specialised Foundation Programme' which provides protected time for research within the first two years of postgraduate clinical training. In this study, we aim to identify what selection criteria are used within the UK Specialised Foundation Programme, and how these relate to demographic factors.MethodsWe will perform a mixed methods study consisting of a document analysis of person specifications and selection criteria used in the 2024 UK Specialised Foundation Programme, and a national cross-sectional survey of current medical students in the UK. We will obtain the person specifications, selection criteria, white space (open ended questions used during shortlisting) and interview questions and mark schemes from each Specialised Unit of Applications via information available on their websites or through Freedom of Information requests. Our survey will collect information relating to demographic data, selection criteria, and perceptions of specialised foundation programme selection.DiscussionInternational literature has demonstrated inequity in academic markers used in selection of post-graduate clinicians and that disadvantages caused by selection can compound over time. As such it is important to understand what inequity exists within the selection of early academic-clinicians, as this can help inform more equitable selection practices and help nurture a more diverse academic-clinical workforce.

In a rapidly changing healthcare environment, we need a robust evidence base to inform effective education and training. This study aimed to examine factors perceived to determine career progression in clinical education research in the UK. Six online focus groups were conducted, with 35 participants from a range of medical, dental, nursing, and allied health professions who identified as aspiring or early career clinical education researchers. Transcripts underwent thematic analysis. Two themes and associated subthemes were constructed to illustrate perceived factors impacting on career development: (1) A cultural challenge from clinical norms. Challenges included differences between the epistemological assumptions of biomedical and clinical research, and the underlying philosophy of education research, which is more closely aligned with the knowledge generation of the social sciences. This led to difficulty communicating the impact of education research to patient care. There were also blurred boundaries between education delivery and research, with the latter lacking a clearly defined group identity. (2) Structures, systems and relationships for career progression. Practical considerations included time and funding (or lack thereof), the opportunity to undertake formal training, networking and role models. This research highlights a number of systemic barriers and facilitators to careers in clinical education research and offers targets of intervention to enable a sustainable academic workforce in clinical education research.

Objectives This study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2? Which of these factors are specific to the context of the COVID-19 pandemic, and the unique experiences of the cohort of doctors who qualified early during the pandemic?Design Sequential explanatory mixed methods study: Quantitative survey. Qualitative semistructured interviews. Quantitative data were analysed with logistic regression. Qualitative data were analysed using reflexive thematic analysis.Setting UK-wide.Participants Junior doctors who graduated medical school in 2020. Survey: 320 participants (22% of those contacted). 68% (n=219) were female, 60% (n=192) under 25 and 35% (n=112) 25–30. 72% (n=230) were white, 18% (n=58) Asian and 3% (n=10) black. Interviews: 20 participants, 10 had applied for specialty training, 10 had not.Results A minority of respondents had applied for specialty training to start in 2022 (114, 36%). While burnout varied, with 15% indicating high burnout, this was not associated with the decision to apply. This decision was predicted by having taken time off due to work-related stress. Those who had not taken time off were 2.4 times more likely to have applied for specialty training (OR=2.43, 95% CI 1.20 to 5.34). Interviews found reasons for not applying included wanting to ‘step off the treadmill’ of training; perceptions of training pathways as inflexible, impacting well-being; and disillusionment with the community and vocation of healthcare, based, in part, on their experiences working through COVID-19.Conclusions Participants infrequently cited factors specific to the pandemic had impacted their decision-making but spoke more broadly about challenges associated with increasing pressure on the health service and an eroded sense of vocation and community.

Clinical education research (ClinEdR) is a growing field that aims to ensure the way healthcare professionals are taught and learn is evidence-based. There is growing interest in how this evidence is generated in a robust, timely and cost-effective fashion. In this 'How to …' paper, we draw on relevant literature and our own experiences to offer suggestions on how novice researchers can navigate entry into the field of ClinEdR. We summarise key resources for those at the earliest stages of their interest in ClinEdR and scholarship and provide personal experiences of networking, collaborating and balancing research with a clinical or teaching role. This paper will be of interest to those at any stage in their clinical career with little to no experience of ClinEdR, but the enthusiasm to get started.

PURPOSE:Understanding the factors that influence prosocial behaviour during the COVID-19 pandemic is essential due to the disruption to healthcare provision.METHODS:We conducted an in-depth, mixed-methods cross-sectional survey, from 2 May 2020 to 15 June 2020, of medical students at medical schools in the United Kingdom. Data analysis was informed by Latané and Darley's theory of prosocial behaviour during an emergency.RESULTS:A total of 1145 medical students from 36 medical schools responded. Although 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. Of the students, 92.7% understood they may be asked to volunteer; however, we found deciding one's responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students' decisions over whether they had the required skills and knowledge.CONCLUSION:We propose two additional domains to Latané and Darley's theory that medical students consider before making their final decision to volunteer: 'logistics' and 'safety'. We highlight modifiable barriers to prosocial behaviour and provide suggestions regarding how the conceptual framework can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process. Key messages  What is already known on this topic: There is a discrepancy between the number of students willing to volunteer during pandemics and disasters, and those who actually volunteer. Understanding the factors that influence prosocial behaviour during the current COVID-19 pandemic and future pandemics and disasters is essential. What this study adds: We expanded on Latané and Darley's theory of prosocial behaviour in an emergency and used this to conceptualize students' motivations to volunteer, highlighting a number of modifiable barriers to prosocial behaviour during the COVID-19 pandemic. How this study might affect research, practice, or policy: We provide suggestions regarding how the conceptual framework can be operationalized to support prosocial behaviours during emergencies for the ongoing COVID-19 pandemic and future crises.

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 ‘lockdown’ period in the UK (March–July 2020). Analysis was informed by the conceptual framework of service and learning. 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual’s experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.Practice pointsThere was a benefit for most students who provided clinical support compared to those who did not during Covid-19.Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team.Not every student’s experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity.The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service.There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations. Practice points There was a benefit for most students who provided clinical support compared to those who did not during Covid-19. Most students found clinical support roles more beneficial than clinical placements and most final years wanted their final year clinical placements replaced by a formal role within a clinical team. Not every student’s experience of clinical support was equal. The conceptual framework of service and learning can help explain this heterogeneity. The most beneficial roles for students complemented the curriculum and provided opportunities for clinical skill development, reflective practice, and meaningful contribution to the health service. There is an added benefit of combining service and learning if done correctly, and we can use this to inform the structure of clinical placements going forwards. However, there are risks, and we discuss principles of good practice and provide our own considerations.

1Academic foundation doctor, Newcastle University, Newcastle, United Kingdom; email: [email protected]; Twitter: @a_c_harvey_b; ORCID: https://orcid.org/0000-0002-9056-8569. Funding/Support: None reported. Other disclosures: None reported. Ethical approval: Reported as not applicable. First published online.

Introduction Professional identity formation is a priority of medical training. Covid-19 caused disruption to medical education. We ask how this disruption impacted professional identity formation through the lens of the activities performed – or not performed – by medical students during the first wave of the covid-19 pandemic, and perceptions of conflicts between these activities. Methods A pragmatic mixed-methods survey was distributed to medical students in the UK. The survey was active from 2nd May to 15th June 2020, during the height of the first wave of the Covid-19 pandemic in the UK. Operating within the paradigm of constructivism, we conducted a reflexive thematic analysis of qualitative responses to three open questions. Analysis was focused around the disruption to medical education, actions taken by medical students during this disruption, and the tension between student actions (where they existed in conflict). Results We analysed 928 responses and constructed three themes: Status and role as a future doctor Status and role as a student Status and role as a member of the wider community Conflict arose at the intersections between these three themes. Students noted that lack of clinical exposure was detrimental to their education, implicitly recognising that some aspects of professional identity formation require the clinical environment. Participants were keen to volunteer clinically, but struggled to balance this and academic work. Participants worried about risk to their families and the wider community and wanted to ensure their skills added value to the clinical environment. Volunteers felt frustrated when they were unable to perform tasks aligning with their identity as a future doctor. An exception was participants who worked as interim FY1s, aligned with the role of an FY1. Conclusions Medical students feel a duty to help during crises. There is conflict when different aspects of their identity demand different actions. Covid-19 heightened issues with developing professional identity for medical students, including lack of a defined role, and perceived undervaluing of their skills by other members of the healthcare team. Care must be taken to nurture professional identity formation even during periods of disruption.

The history of academic conferences is surprisingly long. The first scientific conferences on record were held in 1869 by the British Association for the Advancement of Science: their popularity has ballooned since (Gerwin, 2019). The purpose of an academic conference is multifaceted, but what makes them so popular, a stalwart of the academe despite ongoing and significant sociopolitical change within the last century and a half, is the purpose they serve in connection. Conferences bring researchers together, sharing ideas and encouraging collaboration. Despite the fact that collaboration is at the centre of academic events, and increasing recognition as to the importance of involving trainees within clinical education research, collaboration, particularly with trainees, is relatively lacking within medical education. The MedEd Collaborative was founded in September 2020 to provide opportunities for student and trainee healthcare professionals to lead and engage with education research. The collaborative initially intended to provide an opportunity for students and trainees to develop their research skills while other projects were disrupted due to the impact of the Covid-19 pandemic,1 but in the last 2 years, the organisation has grown, and we have become more ambitious in our aims to support the development of aspiring and early-career clinical education researchers. Members of the collaborative were lucky enough to be at the ASME ASM in Aberdeen this year, presenting work from the CovidReady1 and two studies as well as preliminary results from our most recent interview project.2 Through these presentations, junior members of the collaborative had the opportunity to prepare for and present at a major conference, developing important research dissemination and communication skills. We also valued the input of seniors in the audience at our presentations for their useful comments and questions, which have helped us to approach our projects with appropriate rigour. The collaborative committee were delighted that our CovidReady2 project was awarded a Prestigious Oral Presentation prize. Being immersed in the community of medical educators and researchers allowed us to hear about new and innovative methodologies and discuss ideas for future projects, leaving the conference with greater clarity on the methodology and direction of future research. Alongside presenting our own work, the conference gave ample time for attendees to participate in interactive sessions to develop their own skills. Members of the Collaborative Committee attended the ‘Developing Leadership Education for Trainees’, where we discussed what makes a good leader and reflected on what bad leadership entails. We learnt about leadership guidance, such as the Faculty of Medical Leadership and Management standards for medical—which highlights the importance of effective teamwork to ‘coach individuals to reach their full potential’ and how cross-team collaboration ‘Identifies opportunities for collaboration and partnership, connecting people with diverse, perspectives and interests’, building on practical leadership skills gained through running the Collaborative (FMLM stardards 3rd edition). We attended the ‘ASME ERC Clinical Education Project Design Surgery’, where we mindmapped an educational intervention, using this session as an opportunity to discuss how we can better use mentors and develop strategies to ensure the sustainability of the collaborative. Attending sessions with senior academics in the field, such as the Q&A session with leaders of the Incubator for Clinical Education Research, helped us gain an appreciation for the history and traditions for the field, and the vision for clinical education research going forward, as well as gaining valuable insights from their experience designing, implementing and disseminating clinical education research throughout their careers. We were pleased to represent the organisation at the conference not only to network with other educationalists but also for some of the Steering Committee to meet each other in person for the first time! We also caught up with some of our collaborators, including members of other research collaboratives such as IncisionUK, strengthening our research networks and discussing future research ideas. Through networking with other young educators and academics and discussing the collaborative, we were able to promote our committee recruitment to a new pool of potential members. As a collaborative, we hope that we will continue to build meaningful relationships with other organisations that aim to support budding clinical educators, such as JASME and TASME. While the MedEd Collaborative was born from a desire to capture some of the changes to medical education caused by the impact of the Covid-19 pandemic, the organisation has grown such to be able to take on further projects outside of the context of the pandemic. Our focus now is on how we can identify and prioritise research questions and how we can optimise our collaborative methodology and expand beyond survey based research. We have recently completed a recruitment cycle for the first additions to our steering committee since the organisation was founded, growing our central team to include more expertise and experience and giving new aspiring clinical educators the opportunity to join and shape the organisation. The spirit in which the MedEd collaborative was founded was one of building a community of young clinical educators who require support to enter and thrive within this community of practice. We hope that as the organisation grows, we will continue to welcome new members of the community. You can keep up to date with work of the MedEd Collaborative through our social media, including on Twitter @MedEdCollab or on our website (www.mededcollaborative.org/).

With burgeoning numbers of medical students and an increasing focus on those students learning through ward work, foundation doctors must be better supported to facilitate this teaching, argues Anna Harvey Bluemel

The covid-19 pandemic has not discouraged applications to medical school. Viktorija Kaminskaite and Anna Harvey Bluemel investigate how much has changed in the application process since the start of the pandemic, and how students are adapting

Abstract Introduction COVID-19 led to global disruption of healthcare and many students volunteered to provide clinical support. Volunteering to work was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience. Methods The COVID Ready 2 study is a national cross-sectional study of all medical students at UK medical schools. We will compare opinions of those who did and did not volunteer to determine the educational benefit and issues they faced. We will use thematic analysis to identify themes in qualitative responses, in addition to quantitative analysis. Results The primary objective is to explore the effect of volunteering during the pandemic on medical education in comparison to those who did not volunteer. Our secondary objectives are to identify: whether students would be willing to assume similar roles in a non-pandemic setting; if students found the experience more or less beneficial than traditional hospital placements and reasons for this; what the perceived benefits and disadvantages of volunteering were; the difference in perceived preparedness between students who did and did not volunteer for foundation training year one and the next academic year; training received by volunteers; and to explore issues associated with volunteering, including safety issues and issues with role and competence. Conclusions We anticipate this study will help identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future; and help determine whether formal voluntary roles should be introduced into the non-pandemic medical curriculum.

Highlights from the Sharp Scratch podcast series

ABSTRACTIntroductionCOVID-19 has caused major disruptions to healthcare, with voluntary opportunities offered to medical students to provide clinical support. We used the conceptual framework of prosocial behavior during an emergency – behaviors whose primary focus is benefiting others – to examine volunteering during COVID-19.MethodsWe conducted an in-depth, mixed-methods cross-sectional survey, from 2nd May to 15th June 2020, of medical students studying at UK medical schools. Data analysis was informed by Latane and Darley’s theory of prosocial behavior during an emergency and aimed to understand students’ decision-making processes.ResultsA total of 1145 medical students from 36 medical schools completed the survey. While 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. The majority (92.7%) of students understood that they may be asked to volunteer; however, we found that deciding one’s responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students’ decisions over whether they had the required skills and knowledge to volunteer. Deciding to volunteer depended not only on possession of necessary skills, but also seniority and identification with the nature of volunteering roles offered.ConclusionsWe propose two additional domains to Latane and Darley’s theory of prosocial behavior during an emergency that students consider before making their final decision to volunteer. These are ‘logistics’ – whether it is logistically feasible to volunteer – and ‘safety’ – whether it is safe to volunteer. This study highlights a number of modifiable barriers to prosocial behavior that medical students encounter and provides suggestions regarding how Latane and Darley’s theory of prosocial behavior can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process for all.

Abstract Introduction We aimed to identify the willingness, attitudes, and practice of medical students towards volunteering in a clinical capacity during the COVID-19 pandemic. Method We distributed a cross-sectional survey from 2/5/2020 to 14/6/2020 to all medical students at UK medical schools. Results A total of 1145 medical students from 36 medical schools completed the questionnaire. 82.7% of students were willing to volunteer, but only 34.3% had volunteered. The strongest predictors of willingness to volunteer on multiple linear regression were the beliefs that volunteering to work would benefit their medical education (estimate=0.35±0.03, adjusted P < 0.001) and that they would have a positive impact (estimate=0.33±0.03, adjusted P < 0.001). The majority of students were willing to take up a clinical role and were confident in having the necessary skills, but there was a discrepancy between the role’s students were comfortable performing and those they were assigned. Thematic analysis of the issue’s students would face when volunteering identified five themes: safety, professional practice, pressure to volunteer, finances and logistics, and education. Conclusions This study identifies areas for consideration from those responsible for workforce planning, healthcare provision, and student safety. We provide recommendations to facilitate a volunteering process that is safer for students, staff, and patients.