IntroductionAddressing the shortage of primary-care physicians, especially in remote and rural areas, is a crucial target in many countries. This article introduces the Scottish Graduate Entry Medicine (ScotGEM) programme: a compressed, tailor-made curriculum designed to equip and enthuse its graduates to practice generalist and rural medicine in Scotland, within the ethos of socially accountable medicine.MethodsThis curriculum paper describes ScotGEM in sufficient detail for the reader to translate elements to their own context. It then collates findings from evaluations, research projects and many critical discussions about the programme. This work is used to describe and evaluate the curriculum design and delivery, with a focus on the distributed aspects.ResultsThree key innovations of the curriculum are explored in detail: the Generalist Clinical Mentor (GCM) role; the year-long primary care Longitudinal Integrated Clerkship (LIC); and the Agents of Change curriculum. There are early signs that ScotGEM is encouraging generalist, rural careers within Scotland. There is also growing evidence of the benefits ScotGEM faculty and students bring to the clinical workforce in the distributed settings.DiscussionDistributed programmes require additional organization for students and faculty. Partnerships can be challenging but immensely rewarding. Healthcare partners in rural areas need to be involved early in planning and strong relationships fostered with local “champions.”

INTRODUCTION:In 2016, the Scottish Government commissioned ScotGEM, a generalist focused graduate entry medical programme. The first cohort of 55 students entered in 2018 and will graduate in 2022. Key unique features of ScotGEM include over 50% of clinical education being led by GPs, the creation of a team of dedicated Generalist Clinical Mentors (GCMs) who support this, a geographically dispersed approach to delivery, and a focus on healthcare improvement activities. This presentation will focus on the progress of our inaugural cohort in terms of progression, performance, and career intentions in comparison with the related internationally literature.METHODS:Progression and performance will be reported based upon assessment outcomes. Career intentions were assessed via an electronic questionnaire exploring career preferences, including speciality, location and reasoning distributed to the first three cohorts. We utilised questions derived from key UK and Australian studies to allow direct comparison with the existing literature.RESULTS:The response rate was 77% (126/163). ScotGEM students' progression rate was high and performance directly comparable with Dundee students. A positive attitude towards general practice and emergency medicine careers was reported. A high proportion of students intended to remain in Scotland, with half interested in working in rural or remote settings.DISCUSSION:Overall, results suggest ScotGEM is meeting the aims of its Mission, a finding of key workforce relevance in Scotland and other rural European contexts that supplements the existing international evidence base. The role of GCMs has been instrumental and may be applicable in other areas.

Introduction: ScotGEM is a novel graduate medicine programme in Scotland with a rural generalist focus. This survey-based study aimed to assess the career intentions of ScotGEM students and the various factors influencing them.Methods: An online questionnaire was devised from existing literature that explored students’ interest regarding generalist or specialty career, geographical location, and influencing factors. Free-text responses regarding their primary care career interest and their reasoning behind geographical preferences allowed for qualitative content analysis. Responses were coded inductively and categorised into themes by two independent researchers who then compared and finalised the themes.Results: 126/163 (77%) completed the questionnaire. Content analysis of free-text responses in relation to a negative attitude towards a prospective GP career yielded themes: personal aptitude, emotional toll of GP and uncertainty. Themes in relation to desired geographical preference included: family factors, lifestyle issues and perceptions regarding professional and personal development opportunities.Discussion: The qualitative analysis of factors influencing the career intentions of students on the graduate programme is key to understanding what is important to them. Students who have decided against primary care have realised an early aptitude for specialism due to their experiences, while also witnessing the potential emotional toll of primary care. Family needs may already be dictating where they will choose to work in the future. Lifestyle reasons were in favour of both urban and rural careers, with a sizeable number of responses still uncertain. These findings and their implications are discussed in context of existing international literature on rural medical workforce.

Objectives To examine factors associated with declaration of disability by medical students and doctors, and the association of declared disability with academic performance. Design Observational study using record-linked data collected between 2002 and 2018. Setting UK Medical Education Database is a repository of data relating to training of medical students and doctors. Disability and other data are record-linked. Participants All students starting at a UK medical school between 2002 and 2018 (n=135 930). Main outcome measures Declared disability was categorised by the Higher Education Statistics Authority. Outcomes related to undergraduate academic performance included scores in the educational performance measure (EPM), prescribing safety assessment and situational judgement test. Performance in postgraduate examinations was studied, as well as prior attainment in school examinations and aptitude tests. Results Specific learning disability (SLD) was the most commonly declared disability (3.5% compared with the next most commonly declared disability at 1.0% of n=129 345 all cases in the study), and during the period covered by the data, SLD declarations increased from 1.4% (n=6440 for students starting in 2002) to 4.6% (n=8625 for students starting in 2018). In a logistic regression, the following factors predicted recording of SLD on entry to medical school ((exp(B)±95% CI), p<0.0001 unless otherwise stated): attendance at a fee-paying school (2.306±0.178), graduate status (1.806±0.205), participation of local areas quintile (1.089±0.030), age (1.034±0.012). First year medical students were less likely to declare SLD if they were from a non-white ethnic background (Asian/Asian British 0.324±0.034, black/black British 0.571±0.102, mixed 0.731±0.108, other ethnic groups 0.566±0.120), female (0.913±0.059; p=0.007) or from a low index of multiple deprivation quintile (0.963±0.029); p=0.017. In univariate analysis with Bonferroni corrections applied for multiple tests, no significant difference was observed in the recording of SLD according to socioeconomic class (χ2=5.637, p=1), whether or not a student’s parents had a higher education (χ2=0.140, p=1), or whether or not a student had received a United Kingdom Clinical Aptitude Test (UKCAT) bursary (χ2=7.661, p=0.068). Students who declared SLD at some point in medical school (n=4830) had lower EPM normalised deviate values (−0.390) than those who did not (−0.119) (F=189.872, p<0.001). Those for whom SLD was recorded were as likely to complete the course successfully as those who did not declare disability (93.0% successful completion by those for whom SLD declared from year 1 (n=2480), 92.2% by those for whom SLD declared after year 1 (n=2350), 91.6% by those for whom SD not declared at any point (n=85 180)) (χ2=6.905, p=0.032). Of 3580 first year students who declared SLD, 43.1% had not sat the UKCAT Special Educational Needs aptitude test (which gives extra time for those with special educational needs), while 28% of 2400 registrants for whom SLD was recorded as medical students did not declare it at General Medical Council registration. Conclusions Substantial increases in declaration of SLD may reflect changes in the social and legal environment during the period of the study. Those who declare SLD are just as likely to gain a primary medical qualification as those who do not. For some individuals, disability declaration appears to depend on context, based on differences in numbers declaring SLD before, during and after medical school.

This chapter explains the underpinning disciplines of sociology and psychology, and how understanding these might help in developing a research project. Sociology is the science of understanding society, concerned with the relationships between people, social structures and institutions and wider culture. Psychology is the underpinning of many key concepts in medical education and medical education research – for example, problem-based learning. To illustrate sociology and psychology, case studies from two different perspectives are discussed. Interest in how social factors shape learning in medical education is reflected in the work. When setting out to examine a specific learning experience in medical education, sociologists might ask what social factors, construed in ways outlined in the chapter, might be influential or impactful. Learning styles are defined as the way in which people like to learn, and what is most effective for them. Reading in different fields helps to develop sociological and psychological imagination, and maybe see medical education in a different way.

The UK healthcare system is delivered with primary care at its heart, but despite this auspicious role in the NHS, recruitment and retention into the general practice profession in the last decade has been difficult. There are strong policy drivers to facilitate recruitment into general practice: Health Education England (HEE) have mandated that 50% of all new medical graduates enter general practice;1 the new General Medical Council’s Outcomes for Graduates has provided additional primary care and population health requirements;2 and league tables revealing which medical schools are ‘the best’ in recruiting their graduates to the GP profession are now published.3 However, despite this political noise, there is still a recruitment and retention crisis in the profession, with 39% of GPs indicating a high likelihood of leaving direct patient care in the next 5 years, with this rising to 62% in GPs aged >50 years.4 This is on a wider background of retention challenges in the profession generally, with only 47% of newly qualified doctors exiting the Foundation Programme entering any kind of speciality training.3 In 2016, a critical moment arose where HEE and the Medical Schools Council supported a collaborative task force to expose and explore the role medical schools should have in addressing the crisis in the profession. The By Choice not Chance report chaired by Professor Val Wass, now widely referred to as the ‘ Wass report’, published a series of recommendations giving medical schools guidance and strategies to enable recruitment of their graduates into general practice.5 This report arose from discussions with a series of educators: the British Medical Association; the RCGP; the Society for Academic Primary Care; trainees; undergraduate Deans; and students from medical …

Dundee University School of Medicine established a pilot for a 40 week long comprehensive Longitudinal Integrated Clerkship (LIC) in 2016. Ten places for year 4 students are available which are shared between two regions of Scotland which are largely rural areas by UK definitions. This paper describes the drivers for the pilot, its implementation and early evaluation. For the evaluation, data were collected using focus groups and semi-structured interviews from the first cohort of seven students, four health service employed staff (two with leadership roles and two with regional student facing roles), 21 General Practitioner tutors, and from reflective audio-diaries kept by all students. Analysis was thematic, the themes being identified from the data. Summative assessment data were collated. Students reported positive learning experiences though access to secondary care learning linked to their patients was sometimes problematic. GP tutors were positive and enthusiastic about the programme and could see the potential benefits on recruitment to GP careers. Preexisting workload pressures were a challenge. Summative assessment results were encouraging. The Dundee LIC is successful in delivering Dundee's year 4 curriculum. Ongoing development has been focused on improving awareness of the programme in secondary care services.

Background Educating doctors is expensive and poor performance by future graduates can literally cost lives. Whilst the practice of medicine is highly evidence based, medical education is much less so. Research on medical school selection, undergraduate progression, Fitness to Practise (FtP) and postgraduate careers has been hampered across the globe by the challenges of uniting the data required. This paper describes the creation, structure and access arrangements for the first UK-wide attempt to do so. Overview A collaborative approach has created a research database commencing with all entrants to UK medical schools in 2007 and 2008 (UKMED Phase 1). Here the content is outlined, governance arrangements considered, system access explained, and the potential implications of this new resource discussed. The data currently include achievements prior to medical school entry, admissions tests, graduation point information and also all subsequent data collected by the General Medical Council, including FtP, career progression, annual National Training Survey (NTS) responses, career choice and postgraduate exam performance data. UKMED has grown since the pilot phase with additional datasets; all subsequent years of students/trainees and stronger governance processes. The inclusion of future cohorts and additional information such as admissions scores or bespoke surveys or assessments is now being piloted. Thus, for instance, new scrutiny can be applied to selection techniques and the effectiveness of educational interventions. Data are available free of charge for approved studies from suitable research groups worldwide. Conclusion It is anticipated that UKMED will continue on a rolling basis. This has the potential to radically change the volume and types of research that can be envisaged and, therefore, to improve standards, facilitate workforce planning and support the regulation of medical education and training. This paper aspires to encourage proposals to utilise this exciting resource.

Background Misconduct during medical school predicts subsequent fitness to practise (FtP) events in doctors, but relatively little is known about which factors are associated with such issues during undergraduate education. This study exploits the newly created UK medical education database (UKMED), with the aim of identifying predictors of conduct or health-related issues that could potentially impair FtP. The findings would have implications for policies related to both the selection and support of medical students. Methods Data were available for 14,379 students obtaining provisional registration with the General Medical Council who started medical school in 2007 and 2008. FtP declarations made by students were available, as were various educational and demographic predictor variables, including self-report ‘personality measures’ for students who participated in UK Clinical Aptitude Test (UKCAT) pilot studies. Univariable and multivariable logistic regression models were developed to evaluate the predictors of FtP declarations. Results Significant univariable predictors ( p < 0.05) for conduct-related declarations included male gender, white ethnicity and a non-professional parental background. Male gender (OR 3.07) and higher ‘self-esteem’ (OR 1.45) were independently associated with an increased risk of a conduct issue. Female gender, a non-professional background, and lower self-reported ‘confidence’ were, among others, associated with increased odds of a health-related declaration. Only ‘confidence’ was a significant independent predictor of a health declaration (OR 0.69). Female gender, higher UKCAT score, a non-professional background and lower ‘confidence’ scores were significant predictors of reported depression, and the latter two variables were independent predictors of declared depression. Conclusions White ethnicity and UK nationality were associated with increased odds of both conduct and health-related declarations, as were certain personality traits. Students from non-professional backgrounds may be at increased risk of depression and therefore could benefit from targeted support. The small effect sizes observed for the ‘personality measures’ suggest they would offer little potential benefit for selection, over and above those measures already in use.

Medical EducationVolume 51, Issue 6 p. 670-670 Letter to the Editor Response to Adam et al. regarding selection methods Fiona Patterson, Corresponding Author Fiona Patterson f.patterson@workpsychologygroup.com Work Psychology Group, Derby, UK & University of Cambridge, Cambridge, UKCorrespondence: Fiona Patterson, Work Psychology Group, 27 Brunel Parkway, Pride Park, Derby, UK; Tel: +44(0)1332 295687; Email: f.patterson@workpsychologygroup.comSearch for more papers by this authorAlec Knight, Alec Knight Institute of Psychiatry, Psychology & Neuroscience, King's College London, UKSearch for more papers by this authorJon Dowell, Jon Dowell School of Medicine, University of Dundee, UKSearch for more papers by this authorSandra Nicholson, Sandra Nicholson Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UKSearch for more papers by this authorFran Cousans, Fran Cousans Work Psychology Group, Derby, UK & Occupational Psychology, University of Leicester, UKSearch for more papers by this authorJennifer Cleland, Jennifer Cleland Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UKSearch for more papers by this author Fiona Patterson, Corresponding Author Fiona Patterson f.patterson@workpsychologygroup.com Work Psychology Group, Derby, UK & University of Cambridge, Cambridge, UKCorrespondence: Fiona Patterson, Work Psychology Group, 27 Brunel Parkway, Pride Park, Derby, UK; Tel: +44(0)1332 295687; Email: f.patterson@workpsychologygroup.comSearch for more papers by this authorAlec Knight, Alec Knight Institute of Psychiatry, Psychology & Neuroscience, King's College London, UKSearch for more papers by this authorJon Dowell, Jon Dowell School of Medicine, University of Dundee, UKSearch for more papers by this authorSandra Nicholson, Sandra Nicholson Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UKSearch for more papers by this authorFran Cousans, Fran Cousans Work Psychology Group, Derby, UK & Occupational Psychology, University of Leicester, UKSearch for more papers by this authorJennifer Cleland, Jennifer Cleland Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UKSearch for more papers by this author First published: 27 February 2017 https://doi.org/10.1111/medu.13251Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume51, Issue6June 2017Pages 670-670 RelatedInformation

Background: Medical students have historically largely come from more affluent parts of society, leading many countries to seek to broaden access to medical careers on the grounds of social justice and the perceived benefits of greater workforce diversity. The aim of this study was to examine variation in socioeconomic status (SES) of applicants to study medicine and applicants with an accepted offer from a medical school, comparing the four UK countries and individual medical schools.Methods: Retrospective analysis of application data for 22 UK medical schools 2009/10-2011/12. Data were analysed for all 32,964 UK-domiciled applicants aged <20 years to 22 non-graduate medical schools requiring applicants to sit the United Kingdom Clinical Aptitude Test (UKCAT). Rates of applicants and accepted offers were compared using three measures of SES: (1) Postcode-assigned Index of Multiple Deprivation score (IMD); (2) School type; (3) Parental occupation measured by the National Statistics Socio Economic Classification (NS-SEC).Results: There is a marked social gradient of applicants and applicants with accepted offers with, depending on UK country of residence, 19.7-34.5 % of applicants living in the most affluent tenth of postcodes vs 1.8-5.7 % in the least affluent tenth. However, the majority of applicants in all postcodes had parents in the highest SES occupational group (NS-SEC1). Applicants resident in the most deprived postcodes, with parents from lower SES occupational groups (NS-SEC4/5) and attending non-selective state schools were less likely to obtain an accepted offer of a place at medical school further steepening the observed social gradient. Medical schools varied significantly in the percentage of individuals from NS-SEC 4/5 applying (2.3 %-8.4 %) and gaining an accepted offer (1.2 %-7.7 %).Conclusion: Regardless of the measure, those from less affluent backgrounds are less likely to apply and less likely to gain an accepted offer to study medicine. Postcode-based measures such as IMD may be misleading, but individual measures like NS-SEC can be gamed by applicants. The previously unreported variation between UK countries and between medical schools warrants further investigation as it implies solutions are available but inconsistently applied.

Context Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years. Methods A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design. Results Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness. Conclusions Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.

BACKGROUND:While the construct of integrity has emerged as a front-runner amongst the desirable attributes to select for in medical school admissions, it is less clear how best to assess this characteristic. A potential solution lies in the use of Situational Judgement Tests (SJTs) which have gained popularity due to robust psychometric evidence and potential for large-scale administration. This study aims to explore the psychometric properties of an SJT designed to measure the construct of integrity.METHODS:Ten SJT scenarios, each with five response stems were developed from critical incident interviews with academic and clinical staff. 200 of 520 (38.5 %) Multiple Mini Interview candidates at Dundee Medical School participated in the study during the 2012-2013 admissions cycle. Participants were asked to rate the appropriateness of each SJT response on a 4-point likert scale as well as complete the HEXACO personality inventory and a face validity questionnaire. Pearson's correlations and descriptive statistics were used to examine the associations between SJT score, HEXACO personality traits, pre-admissions measures namely academic and United Kingdom Clinical Aptitude Test (UKCAT) scores, as well as acceptability.RESULTS:Cronbach's alpha reliability for the SJT was .64. Statistically significant correlations ranging from .16 to .36 (.22 to .53 disattenuated) were observed between SJT score and the honesty-humility (integrity), conscientiousness, extraversion and agreeableness dimensions of the HEXACO inventory. A significant correlation of .32 (.47 disattenuated) was observed between SJT and MMI scores and no significant relationship with the UKCAT. Participant reactions to the SJTs were generally positive.CONCLUSIONS:Initial findings are encouraging regarding the psychometric robustness of an integrity-based SJT for medical student selection, with significant associations found between the SJTs, integrity, other desirable personality traits and the MMI. The SJTs showed little or no redundancy with cognitive ability. Results suggest that carefully-designed SJTs may augment more costly MMIs.

Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored.

Electives are part of most Western medical school curricula. It is estimated that each year 3000–4000 undergraduate medical students from the UK alone undertake an elective in a developing country. The impact of these electives has given some cause for concern, but the views of elective hosts are largely missing from the debate.

Background International medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population. Methods This was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students. Results 109 students participated (45% of class). Of this 41.3% (n = 45) were Non-EU and 35.8% (n = 39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r = 0.5, P<0.01). Correlations emerged between First Year results and IELTS (r = 0.44; p = 0.006; n = 38) and EU school exit exam (r = 0.52; p<0.001; n = 56). MMI predicted EU student OSCE performance (r = 0.27; p = 0.03; n = 64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates. Conclusion MMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background.