Preparedness for Practice
It is vital that in every health and care profession, graduates are as well prepared as possible for their first day of work. For example, there is evidence to suggest that when trainee doctors start their first work placement as a Foundation Year 1 doctor (F1) it has a negative impact on patient safety and can have an impact on the functioning of the broader healthcare team. Similarly, the transition from student to professional nurse has been identified as a period of considerable turbulence, strain and anxiety.
PIHR has a rich collection of research related to the education and preparedness to practice of a wide range of health and care professionals.
The UK is heavily dependent on overseas qualified doctors to staff its healthcare system. According to the General Medical Council’s Workforce Report 2019, over 34.5% of doctors on the register received their primary medical qualification abroad, while 4% of doctors leave the UK medical workforce each year.
In light of these issues, a team from CAMERa, led by Dr Nicola Brennan and involving Professor Thomas Gale and Dr Marie Bryce, undertook a project for the General Medical Council to investigate patterns of doctors to and from the UK. Their report found an increasing dependence on non-UK trained doctors (particularly from India, Pakistan, Sudan, Egypt and Nigeria) to staff the UK’s healthcare system. The research also found that the decision for a doctor to migrate is multi-layered and is a complex balance between push/pull factors at macro-/meso-/micro-levels.
Mental health and wellbeing
PIHR researchers are engaging in workforce stress related research across a number of clinical areas, including social work, nursing and midwifery and have also been looking at the need for recovery amongst emergency physicians in the UK and Ireland.
Recent examples include a rapid evidence review on the mental health of dental professionals. The study led by Anastasios Plessas, in collaboration with the University of Southampton and with funding from the General Dental Council, concluded that dentists suffer an increased level of stress and burnout, particularly general dental practitioners, with litigation and regulation the main stressors. Similarly research led by Professor Bridie Kent, involving surveys of the UK nursing and midwifery workforce found concerning levels of post-traumatic stress disorder (PTSD), stress and anxiety in respondents. Meanwhile Professor Jos Latour has explored the need for recovery and physician well-being in emergency departments, while Dr Susie Pearce and Professor Mary Hickson have secured funding from the Torbay Medical Research Fund for research to develop the clinical academic careers for nurses, midwives and allied health professional in Torbay and South Devon.
Stress arising from unmanageable case-loads is thought to be one of the main reasons why the average career span for social workers is less than eight years. Associate Professor Dr Oliver Beer’s research has primarily focused on the health and well-being of the child protection workforce, utilising innovative approaches to prevent and reduce work-related stress. He has also undertaken research on the workforce more widely including the perception of stress amongst social workers and the role of coping strategies. Meanwhile Dr Beth Moran's research has focused on how to best support social work students in practice placements particularly with regards to dealing with the emotional context and stresses of the work. She is also leading on a £52,593 project for the Health and Care Professions Council on preparedness for practice.
Further details of research related to social workers can be found on the Social Work Research Group webpage.
Work conditions: remediation and professional support
Currently the NHS routinely provides professional support services (including remediation) for doctors. These provide help, guidance and access to additional training and support for doctors, to help with career development and to remedy problems they may have. Professional support covers a range of activities e.g. communication skills training, mentoring or coaching, resilience training. Research on professional support is generally sparse and in particular we do not know enough about how the different approaches to professional support work in the NHS. This could result in professional support being conducted ineffectively, wasting doctors’ time and taxpayers’ money.
Members of the CAMERa team are investigating several aspects of professional support and remediation, including how remediation interventions produces their effects, the impact of remediation on professional identities, the remediation of professionalism lapses and optimising the delivery of professional support programmes.
RESTORE 1 was conducted in collaboration with the Universities of Oxford and Aberdeen. This used realist review methods to develop a programme theory to explain how remediation interventions produce their effects. It is fundamental to understand the theory of how remediation of doctors is supposed to work, for whom and the contexts that lead to different outcomes, in order to design high-quality remediation interventions. The findings of this review were used to develop guidelines for tailoring and implementing effective remediation interventions for practising doctors. The study was funded by the NIHR Health and Social Care Delivery Research Programme.
Led by Dr Nicola Brennan, Associate Professor in Medical Education (Research), a team from the Collaboration for the Advancement of Medical Education Research and Assessment (CAMERa) research group in collaboration with the University of Oxford are undertaking a £742K project looking at how the NHS can optimise professional support programmes.
Remediation and professional identity
An important and under researched area on the remediation agenda is the impact undergoing a remediation programme has on the identity of a doctor. A PhD studentship being undertaken by Dr Jamie Read is using questionnaires and interviews to understand how remediation impacts on the professional identities of medical students and identify how remediation might be used to support appropriate identity formation. The output of the PhD will include a conceptual framework, from which interventions that better support students can be developed.
Remediation of professionalism lapses
The CAMERa team have a particular interest in the remediation of professionalism lapses in doctors and have carried out a systematic review of the literature to synthesise the evidence on existing interventions in this area. This review highlights the additional complexities of remediating professionalism issues compared to knowledge and skills.
Work conditions: professional regulation
CAMERa is a leading centre in health professions regulation research, with our work including research on a range of regulatory policies and processes, including Fitness to Practise, licensing and revalidation. We engage with key stakeholders to inform policy development and implementation and to understand the impacts of regulation on professional practice.
Our research in this theme also links to work across other CAMERa themes, as professional regulators play a key role in setting educational standards and quality assuring professional education, and are also taking an increasing interest in workforce issues.
Fitness to Practise
Fitness to practise processes are a central feature of professional regulation, and our work in this area explores: the complaints and referrals which prompt fitness to practise proceedings; the functioning of fitness to practise procedures themselves; and quantitative analyses of trends within fitness to practise data.
CAMERa’s fitness to practise research includes studies commissioned by the General Dental Council (GDC), the Nursing and Midwifery Council (NMC), and the General Medical Council (GMC).
Recent work has focused on seriousness in fitness to practice, exploring how the concept is understood and applied by within professional regulation. In 2018, they undertook a literature review on this topic, commissioned by the General Dental Council, and in 2022 they completed a report on how seriousness in Fitness to Practice (FtP) cases is understood and applied by UK health professions regulators for the GDC and NMC.
As well as work on regulatory fitness to practice procedures, we also undertake research into local and organisational performance management and disciplinary processes for healthcare professionals.
Since 2010, CAMERa has undertaken research into the development and introduction of medical revalidation, a relicensing process which aims to ensure that doctors remain up-to-date and fit to practice through engagement in appraisal processes. Our team took part in two major national evaluations of the implementation of this flagship regulatory policy, between 2015 and 2018, funded by the General Medical Council and the Department of Health Policy Research Programme. This programme of work explored the impacts of revalidation for the medical profession and for healthcare organisations.
The introduction of a national medical licensing assessment in the United Kingdom is a major change in medical education in the UK, and CAMERa was commissioned by the General Medical Council to synthesis the evidence base on the impact of these types of assessments internationally.
Recruitment and Widening Participation
Recruitment is currently a major challenge across the NHS. However for some Allied Health Professions (AHPs) the issues are particularly stark. Health Education England (HEE) have coined the phrase ‘small and vulnerable / vital professions’ in relation to four AHPs: Orthoptics, Orthotics and Prosthetics, Podiatry and therapeutic radiography. Similar concerns also exist for Radiography and Operation Department Practice (ODPs). However many Armed Forces personnel (AFPs) retire from the services with a range of medical competencies that could be applied in AHP roles.
With funding from HEE, Dr Sally Abey has been working with Zoe Grant at the University of Suffolk and Amanda Cox from the University of Leicester on a project to help establish a new supply chain for AFPs into higher education and specifically the following degree level programmes: Diagnostic radiography, ODP, Orthoptics, Orthotics and Prosthetics, Podiatry, and Therapeutic Radiography. The project includes researching which qualifications are required by AFPs on entry to medical branches, identifying those which are and are not tarrifable to higher education and examining the gaps.
In the long-term developing interest among young people is going to be an important component of addressing recruitment to AHPs. With this in mind, Sally is also leading on a project to develop six healthcare Girl Guide Award Challenges for occupational therapy, physiotherapy, optometry, social work, paramedicine and podiatry. The team is currently researching whether the challenge has:
- promoted foot health
- created positive associations with feet
- promoted the profession of podiatry.
Contributing to Net Zero
Medical, nursing and Allied Health Professionals (AHP) are crucial players in the NHS’s commitment to becoming a ‘Net Zero’ NHS. The effective implementation of this goal requires strategic vision and resourcefulness from educators, practitioners and students (future leaders).
The climate emergency is also a health emergency, threatening the core purpose of the NHS, putting at risk the health and wellbeing of patients and communities. Unabated, climate change will disrupt care, affecting patients and the public at every stage of their lives. Visionary change-makers, therefore, are crucial to support current and future NHS green leaders. Dr Clare Pettinger has reviewed sustainable eating for nutrition professionals, working closely with her professional body (the BDA) to champion both pedagogic research and practical policy application via the pioneering One Blue Dot Toolkit. This has led to her co-developing the new Greener AHP hub. She is also working with the Business School on ‘collaborative leadership for sustainability in AHPs’ to develop this work further.
Similarly Dr Daniela Oehring, Associate Professor in Optometry, has been undertaking research around healthcare students' and professionals' attitudes towards sustainability and healthcare. This mixed methods project involves an extensive literature review, written questionnaires of healthcare educators and subsequently, and semi-structured interviews of healthcare professionals, academics, and students. It will consider the key obstacles to professionals and students supporting environmental sustainability, and how these can be overcome.
The Collaboration for the Advancement of Medical Education Research and Assessment (CAMERa) researchers aim to improve the development and sustainability of the healthcare workforce by focusing on three research themes, namely workforce development, continuum of education, and professional regulation.
CAMERa's research programme, carried out by a multi-professional group and employing a mix of qualitative and quantitative methods, impacts directly on national and international literature, educational theory, practice and policy.