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Article
Publication date: 13 November 2020

Prakash Subedi, Jill Aylott, Naushad Khan, Niki Shrestha, Dayaram Lamsal and Pamela Goff

The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and…

Abstract

Purpose

The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.

Design/methodology/approach

A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.

Findings

The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.

Research limitations/implications

The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.

Practical implications

The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.

Originality/value

This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

Details

Leadership in Health Services, vol. 34 no. 3
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 1 April 1998

Guy Houghton and Baron Mendes da Costa

The Evidence Supported Medicine Union (EMU) was formed in the West Midlands to introduce and develop the ideas of evidence‐based medicine into general and hospital…

Abstract

The Evidence Supported Medicine Union (EMU) was formed in the West Midlands to introduce and develop the ideas of evidence‐based medicine into general and hospital practice. To understand the educational needs of multi‐disciplinary members of acute trusts, a series of half‐day workshops were planned. All acute trusts accepted the invitation to send multi‐disciplinary teams — delegates attended in total in groups varying from one to nine. The major needs of acute trusts were: 1. critical appraisal skills, 2. multi‐disciplinary training workshops, 3. prioritizing areas for evidence‐based medicine, and 4. linking evidence‐based medicine into clinical audit.

Details

Journal of Clinical Effectiveness, vol. 3 no. 4
Type: Research Article
ISSN: 1361-5874

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Article
Publication date: 9 August 2011

Michael Ogundele

This article aims to review the available literature on how clinicians meet the daily challenge of translating medical information into clinical EBM. It also seeks to…

Abstract

Purpose

This article aims to review the available literature on how clinicians meet the daily challenge of translating medical information into clinical EBM. It also seeks to describe the procedures involved in a local initiative in the UK to develop software applications for implementation of national clinical guidelines to enhance EBM in routine clinical practice.

Design/methodology/approach

It was hypothesised that improved access to these guidelines in routine clinical practice could be achieved through integrated local procedures, thereby enhancing the quality of care provided to children and adolescents with asthma or UTI. A literature search was performed using databases. To explore the preferences of the doctors and other healthcare professionals on how they accessed clinical guidelines, feedback was obtained. Stepwise implementation of the clinical guidelines was instituted over a period of three years in different primary care and hospital settings.

Findings

The professionals actively engaged with all the different stages in the implementation of the clinical guidelines. The majority preferred the interactive computerized system based on its ease of use, better aesthetic features, familiarity with the software and limited dependence on the technical skills of the users.

Research limitations/implications

The limitations of this study include lack of systematic data to assess the clinical effectiveness of the guidelines' implementation. Another apparent limitation of the study is the small size of participants within the paediatric unit of each organisation where the study was conducted.

Practical implications

There is a need for further comparative studies between the local intervention strategies described in this study and other implementation strategies, to identify the most effective implementation methods for electronic guideline‐based systems.

Social implications

Reliable high quality guidelines from reputable professional bodies could be successfully implemented at the primary or hospital‐based levels through a series of coordinated multidisciplinary interactive processes. This study has positive implications for improving the quality of care provided to children and adolescents, enhancing the role of clinical governance, provision of useful information to patients/carers and other healthcare providers.

Originality/value

This study highlights a potentially effective way of implementing and integrating an electronic guideline‐based computer system into local practice.

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Article
Publication date: 1 February 2006

Keng Boon Harold Tan

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG…

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Abstract

Purpose

Clinical practice guidelines (CPGs) have been developed for many years with the aim of improving the quality of care. A review of the use of CPGs and assessments of CPG compliance among practitioners so far would aid the understanding of factors influencing CPG compliance. This study seeks to provide this.

Design/methodology/approach

A general review and discussion of CPGs in areas of their attributes, benefits and pitfalls were carried out. Articles concerning the assessment of CPG compliance were also reviewed to understand the kind of data collected for such assessments (qualitative vs quantitative), the methods used to collect data (objective versus subjective), and the assessment measures employed (process versus outcome).

Findings

A total of 57 CPG compliance assessment studies were reviewed. Almost two‐thirds employed objective methods. Of the subjective assessments, 47 per cent analysed solely quantitative data, 32 per cent analysed solely qualitative information and 21 per cent analysed both. More than four‐fifths of all studies used process measures to determine CPG compliance and only 5 per cent used solely outcome measures.

Practical implications

Depending on the methods used, assessments can help identify various factors influencing CPG compliance. Such factors may be related to the physician, guidelines, health system or patient. A good understanding of these factors and their role in influencing compliance behaviour will help health regulators and administrators plan better and more effective strategies to improve doctors' CPG compliance.

Originality/value

This review looks at the various aspects of CPGs to understand how these influence practitioners' compliance.

Details

International Journal of Health Care Quality Assurance, vol. 19 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 25 June 2020

Hillary R. Bogner, Stephanie Abbuhl, Lucy Wolf Tuton, Bridget Dougherty, Diana Zarowin, Alejandra Guevara and Heather McClintock

Recruiting medical students into women’s health and gender-based medical research is important internationally. Medical student research training is critical for…

Abstract

Purpose

Recruiting medical students into women’s health and gender-based medical research is important internationally. Medical student research training is critical for developing future women’s health leaders who are adept at conducting high-impact research. This paper aims to describe a six-month medical student research fellowship in women’s health in terms of fellowship recipients’ publications related to their research project and future academic careers.

Design/methodology/approach

Targeted searches of fellowship recipients and their fellowship mentors were conducted in PubMed and Scopus from 2001–2017. Prior student fellows were also e-mailed and called to assess whether they held academic positions.

Findings

Since 2001, funds have been secured to support a total of 83 students (69 women, 14 men) in a mentored research experience in women’s health and gender-based medicine. In total, 48 out of the 83 (57.8%) medical student fellowship recipients published at least one peer-reviewed research paper or scientific review related to their research project. Of the 50 prior recipients with a least five years of follow-up data (41 women, 9 men), 26 (52%) were in academic careers.

Research limitations/implications

Because this is an observational study and only medical students interested in women’s health applied to be a student fellow, there is an inability to infer causality.

Practical implications

Following completion of the medical student research training fellowship in women’s health, more than half of recipients published in peer-reviewed medical journals on their research project.

Originality/value

This study explores the association of an innovative medical student experience in women’s health research on subsequent fellowship-related publications and career outcomes, contributing to the body of knowledge on the influence of a mentored research leadership program for medical students on academic professional development.

Details

Leadership in Health Services, vol. 33 no. 3
Type: Research Article
ISSN: 1751-1879

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Article
Publication date: 17 August 2012

Duan Li‐zhong, Duan Gu‐na, Zhai Guang‐Qian, Zhang Ying, Xuan Chun‐Yu and Geng Hao

The purpose of this paper is to strengthen and standardize general hospital use of traditional Chinese medicine, strengthen the inner construction, highlight the…

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Abstract

Purpose

The purpose of this paper is to strengthen and standardize general hospital use of traditional Chinese medicine, strengthen the inner construction, highlight the characteristics and advantages of Chinese medicine and improve Chinese medicine services' capacity and competitiveness.

Design/methodology/approach

Through data analysis and face‐to‐face interviews, the influential factors for Chinese medicine use in general hospitals are found and the extent and impact of these factors are researched. Based on survey results, grey relational analysis is used to analyze the actual factors.

Findings

Based on the results of grey relational analysis, a clear order of these factors on the degree of influence is obtained and suggestions are offered which can promote the development of traditional Chinese medicine in general hospitals.

Originality/value

The grey system theory was applied in medical management. The influential factors for Chinese medicine use in general hospitals was analyzed by using grey relational analysis, to offer the relevant departments several operational recommendations which can accelerate the development of general hospital use of traditional Chinese medicine.

Details

Grey Systems: Theory and Application, vol. 2 no. 2
Type: Research Article
ISSN: 2043-9377

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Article
Publication date: 24 November 2009

Judy McKimm, David Rankin, Phillippa Poole, Tim Swanwick and Mark Barrow

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in…

Abstract

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

Details

International Journal of Leadership in Public Services, vol. 5 no. 3
Type: Research Article
ISSN: 1747-9886

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Book part
Publication date: 25 September 2015

Maria Tsouroufli

In this introductory chapter, I discuss the rationale for this edited collection and the contribution it can make to advancing knowledge of gender inequalities and…

Abstract

In this introductory chapter, I discuss the rationale for this edited collection and the contribution it can make to advancing knowledge of gender inequalities and promoting social justice in the medical profession and medical education. I provide a short overview of and critique of popular debates in the medical community in the United Kingdom and I also discuss briefly research about women’s careers in the United Kingdom and globally. The introductory chapter provides a description of each chapter and its contribution to scholarship about gender, careers and inequalities in Medicine/Medical Education.

Details

Gender, Careers and Inequalities in Medicine and Medical Education: International Perspectives
Type: Book
ISBN: 978-1-78441-689-8

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Book part
Publication date: 25 September 2015

Judy McKimm, Ana Sergio Da Silva, Suzanne Edwards, Jennene Greenhill and Celia Taylor

Women remain under-represented in leadership positions in both clinical medicine and medical education, despite a rapid increase in the proportion of women in the medical…

Abstract

Women remain under-represented in leadership positions in both clinical medicine and medical education, despite a rapid increase in the proportion of women in the medical profession. This chapter explores potential reasons for this under-representation and how it can be ameliorated, drawing on a range of international literatures, theories and practices. We consider both the ‘demand’ for and ‘supply’ of women as leaders, by examining: how evolving theories of leadership help to explain women’s’ leadership roles and opportunities, how employment patterns theory and gender schemas help to explain women’s career choices, how women aspiring to leadership can be affected by the ‘glass ceiling’ and the ‘glass cliff’ and the importance of professional development and mentoring initiatives. We conclude that high-level national strategies will need to be reinforced by real shifts in culture and structures before women and men are equally valued for their leadership and followership contributions in medicine and medical education.

Details

Gender, Careers and Inequalities in Medicine and Medical Education: International Perspectives
Type: Book
ISBN: 978-1-78441-689-8

Keywords

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Book part
Publication date: 23 October 2003

Erica S Breslau

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from…

Abstract

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.

Details

Gender Perspectives on Health and Medicine
Type: Book
ISBN: 978-1-84950-239-9

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