Group run by academics from University of Bristol Medical School with an interest in Medical Education Research. Opinions expressed are those of the authors and not of Bristol Medical School or the University.
This month’s highlighted Educator Profile is Dr Ed Luff
Ed is an Emergency Medical Doctor and Bristol Medical School graduate. His role is currently split between working as a Clinical Lecturer at Bristol Medical School and Speciality Teaching Fellow and Tutor at South Bristol Academy, based in the Bristol Royal Infirmary.
He is also finishing his MSc dissertation exploring students’ experiences and perceptions of using simulation as a method to teach human factors and non-technical skills, as part of his studies on the Health Professionals Education (TLHP) course.
The mission and aim of the ClinEdR Incubator is to support and promote careers in clinical education research through building a multi-professional community of practice. It extends across all health professions and aims to bring people together to develop their ideas, build collaborations and provide a network of developing experience in the field.
What is Clinical Education Research?
This is one of the most fundamental questions and tends to have a myriad of different definitions and terms including clinical, medical, and healthcare professionals education research to name just a few. Often the word ‘clinical’ can drive the idea that this sort of research must have a direct impact in clinical practice and thus can seem to exclude certain areas of research in education.
The team at the Incubator have tried to broaden this idea, embracing all sorts of different research that can and does have an impact on societal health needs by “enhancing the education, training and development of health and social care practitioners, and the organisations within which they work and learn“. They highlight a number of different areas in which individuals and teams may be undertaking clinical education research such as:
Pedagogical research
Planning and design of educational programmes
Regulation processes
Organisation context of learning, such as learning environments and workforce inclusivity
Learner experience and careers
They also consider that this whilst this type of research may have a direct clinical impact for patients it may achieve impact in other ways such as benefiting clinicians in their training, influencing health and education systems and through challenging and developing standards.
How can the Incubator help those who want to engage in Clinical Education Research?
The incubator is a fantastic place to start regardless of where you are in your ClinEdR journey. It offers a variety of resource and links via it’s website such as:
This week’s blog is a reminder to check out the BMERG profiles pages. This is where we highlight some of our University of Bristol Medical Educators. They share their projects and their journeys to inspire others considering a career in Medical Education.
Our latest profile is Dr David Hettle, a passionate educator working as an Honorary Senior Clinical Teaching Fellow, alongside clinical training in Infectious Diseases and Microbiology. They are involved in work supporting and promoting educator development both locally and nationally through work with the Developing Medical Educators group (DMEG) of the Academy of Medical Educators.
Adding to our BMERG Journal Club series, this month Dr Claire Hudson reflects on the discussion from our January journal club focussing on Cultural Competency.
This paper was chosen by my colleague, Assoc. Prof Liang-Fong Wong, who has a combined interest in cultural competency and medical education, being Year 4 co-lead for our undergraduate MBChB programme and Associate Pro Vice-Chancellor for Internationalisation. Both Liang and I are keen to develop our qualitative research skills, and at first glance, this paper seemed like an excellent example of a qualitative study.
What is ‘Cultural Competency’?
Liu et al suggest culturally competent healthcare professionals should “communicate effectively and care for patients from diverse social and cultural backgrounds, and to recognize and appropriately address racial, cultural, gender and other sociocultural relevant biases in healthcare delivery”; others have defined attributes of culture competency including “cultural awareness, cultural knowledge, cultural skill, cultural sensitivity, cultural interaction, and cultural understanding”. These concepts were explained effectively at the start of the paper; I felt the authors provided me with context for my subsequent reading.
What was the research?
The authors perceived that teaching of cultural competency is inconsistent across medical schools, and there is a paucity of evidence for how effective the teaching is, and how students actually develop their cultural competency throughout their training. They aimed to describe students’ experiences of learning and developing cultural competency, using an ethnographic approach. They carried out student observations, interviews and focus groups; recruiting participants from a central London medical school.
What were the findings?
There is a wealth of qualitative data and discussion presented in the paper, so perhaps the authors could summarise their overall findings in a clearer way. They suggest that students develop cultural competency in stages; in the pre-clinical years they have formal teaching opportunities, and as their clinical exposure increases, the culture content becomes embedded and derived from other learning experiences, including intercalation and placements. They highlight the importance of learning from patients’ lived experiences, from peers and from other (non-medical) student communities.
What did we think?
Clear descriptions: I come from a quantitative, scientific background, therefore I find reading qualitative papers quite challenging; the terminology used is noticeably different and somewhat out of my ‘comfort zone’! Having said that, the authors very clearly explained the basis of ethnography and reflexivity, which really helped us understand the rationale for them adopting these approaches. Data collection and analysis were explained in detail which reassured us that these were robust and valid. However, thorough descriptions mean a long paper; and it could be more concise in places.
Awareness of limitations: A strength of this research was the authors’ transparency about some of its limitations. For example, they acknowledged a potential bias in participant recruitment due to the main author’s own cultural background, but described ways to mitigate this. We found it really interesting that the authors observed different dynamics in the interviews and focus groups depending on the facilitator. In those conducted by a PhD student, a rapport was built such that the students were relaxed and open with their communication, allowing them to be critical about the cultural competency teaching they had received. Conversely, in those conducted by a medical school academic, students were more reserved and tended to be positive about the teaching, highlighting an obvious teacher-student power dynamic. Importantly, this was acknowledged, and adjustments were made. Our biggest take-home message: Carefully consider who facilitates interviews and focus groups so there are no conflicts of interest, and trust is fostered between participants and researchers. Otherwise, students may just tell you what you want to hear!
Evaluation to recommendations: We also remarked that the authors have been clever in the way they present this study for publication. Essentially, they have carried out an internal evaluation of cultural competency teaching in their own medical school, but they have externalised this by making a series of recommendations. They benefit from a very diverse student population, and showcase some really good practice in cultural competency teaching which could be adopted by medical schools.
Overall reflections
Reading this paper made us reflect on non-clinical teaching on other programmes; it is important to remember that diverse student populations increase cultural awareness in all settings. Widening participation schemes and overseas students are important for this. During group work, I try to make the groups as diverse as possible, and I believe this is a positive experience.
The study highlighted different levels of engagement from students with cultural competency teaching, some thought it was ‘pointless’ as they were already culturally competent, or they thought the skills were ‘soft’ and would rather be learning facts, other found it really valuable. This is familiar when teaching other skills in other disciplines; the constant battle getting ‘buy-in’ from students, highlighting the need to always explain ‘Why’ certain teaching is important.
This study is a good showcase for qualitative research, and I made a mental note to refer back to this paper when developing my own qualitative research in the future; which must be a good sign!
Have you seen our educator and researcher profile page? As part of our objective to ‘Innovate and Inspire’, this page is dedicated to showcasing not only the work of individuals working as educators and researchers in medical education at Bristol, but also a bit about their journey and their top tips for working in the discipline.
This month our featured educator is Dr Grace Pearson, a clinical lecturer and specialty doctor in Severn deanery.
Following her recent completion of a Ph.D. Fellowship in undergraduate education in geriatric medicine, Grace is actively innovating and evaluating geriatrics curricula on both local and national scales. This strategic approach ensures the continual enhancement of medical education in geriatric medicine.
To learn more about Grace’ Pearson’s work and that of other educators at Bristol Medical School, we invite you to explore their profiles on our BRMS Educator Profiles page.
In the second hot topics blog of 2024, Fiona Holmes considers the benefits and challenges of interdisciplinary learning. The inspiration for this came from teaching Clinical Perfusion Science students (clinical scientists who operate the heart-lung bypass during cardiac surgery) who come from different disciplinary backgrounds (bioscience/bioengineering and nursing/ODP), and who learn together and from each other and work as part of a complex multidisciplinary team.
The World Health Organisation defines interdisciplinary learning (IDL) as ‘students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes’ and has stated that ‘interprofessional education and collaborative practice can play a significant role in mitigating many of the challenges faced by health systems around the world’.
What are the benefits of IDL?
Shared knowledge. Healthcare students face careers in increasingly complex healthcare systems where mutual understanding and integration of complementary expertise, communication, collaboration and decision making is key to comprehensive patient care and best outcomes. Medical issues and clinical situations often require a holistic understanding that goes beyond a single discipline; generalists and specialists need to work together. Practioners can’t know everything about everything!
Widened horizons. IDL can help students appreciate the interconnectedness of various factors important for patient care such as physiological, psychological, and social. IDL can expose students to different knowledge and perspectives such that they can analyse complex cases from different angles and integrate knowledge leading to more effective problem-solving in clinical settings. It can increase the ability to recognise bias, think critically and tolerate ambiguity.
Effective teamwork. IDL develops effective communication, collaboration and teamwork among healthcare professionals, important for delivering comprehensive and coordinated patient care. This can better prepare students for work in diverse healthcare settings and equip them with broader skills, enabling them to be more versatile and adaptable in their careers and enhancing their professional development.
Improved student experience. IDL can improve the student experience; by and large studies have shown that students express higher levels of engagement and satisfaction when exposed to IDL, which can contribute to improved learning outcomes.
How can IDL be implemented?
IDL can be incorporated into medical education in a number of ways, but to be effective it needs to be purposefully integrated into the curriculum and explicit in learning sessions (you can’t just throw students together and expect the learning to happen spontaneously). IDL lends itself to learning opportunities that can be designed to be authentic real-life situations such as:
Case-based learning (CBL) – students work together on case studies that require input from various professions to help them understand each other’s roles and contributions to patient care;
Simulated scenarios / role playing– students from different professions (or playing the role of different professions) collaborate to address the simulated patient’s needs, honing their teamwork and communication skills in a safe environment as well as understand the perspectives and responsibilities of each profession;
Interprofessional clinical experiences – students from various professions complete clinical placements together to expose them to the interprofessional dynamics of healthcare delivery in reality;
Team-based learning (e.g. clinical rounds)– students discuss patient cases and treatment plans collaboratively (builds upon CBL);
Interprofessional workshops/projects – bring students from various disciplines together to collaborate and develop solutions for healthcare challenges;
Reflective practices – such as team debriefing sessions and individual reflective journals to contemplate experiences, challenges, insights and opportunities for improvement, with a focus on the IDL.
What are the challenges of IDL?
Resource implications. Implementing IDL can pose logistical and resourcing (appropriately skilled staff – ideally interprofessional team teaching, time, costs) challenges; it can be difficult to coordinate curricula and schedules to bring different healthcare students together at appropriate time in their educational journey.
Timing. The jury is out as to when is the best time to implement IDL and for how long (e.g., periodic exposure or continuous immersion). Ideally team dynamics need time to develop, so communication becomes more open and collaborative, with trust and appreciation of diversity of knowledge.
Experience levels. While the point of IDL is to bring together diverse students for learning, there may be issues associated with this such as: Learner-level matching (do they have sufficient background knowledge and experience to work together effectively?); differences in learning preferences may be more exaggerated due to prior teaching and learning experiences; epistemics (the disciplinary ideas about what knowledge is and how to use and produce knowledge) and specific manner of communication are part of the culture of particular disciplines that may hinder IDL.
Perceptions and Biases. Perceptual barriers in competence perceptions may lead to a lack of self-confidence or respect for co-learners and personal characteristics such as curiosity, respect, and openness, patience, diligence, and self-regulation have been suggested to be important characteristics for enabling cognitive advancement in IDL.
Measures of impact. Evaluating the effectiveness of IDL can be challenging. Traditional assessment methods may not adequately capture the depth and breadth of knowledge, behaviour and attitudes or ‘interdisciplinary thinking and doing’ – i.e., the capacity to integrate knowledge and ways of thinking and doing across areas of expertise to produce a better outcome than could be achieved otherwise.
Future Research
While the general consensus is that IDL should be an integral part of the curriculum for healthcare students, the importance of IDL is largely based on theory and there remains a lack of large, multi-centre long-term studies. Therefore, currently it is unclear what strategies are best for long-term behaviour change and positive patient outcomes.
In this blog, Dr Liang-Fong Wong shares some key insights into how we foster an inclusive environment for international students within our university academic systems and culture.
This is an area of work that is close to my heart – being an international student at Bristol myself many moons ago, my international roles, and serendipitously, it was being organised by my netball teammate Catriona Johnson, from the Centre for Academic Language and Development (CALD).
L-R: Assoc Prof Liang-Fong Wong, Dr Fiona Holmes, and Dr Claire Hudson at BILT International Student Experience workshop, 2023.
Catriona and I had previously shared many courtside and car conversations about her project work on academic language and literacy, but have never interacted within our work capacities. I was delighted to turn up on the day to find fellow BMERG members Fiona Holmes and Claire Hudson there as well!
International staff and students are an important community at our institution: they are invaluable to the diversity of our campuses, adding richness and vibrancy to our learning environments and making us all much better global citizens for now and the future. There is so much that we can learn from each other across different cultures.
During the session, we were given an overview of the numerous BILT-funded projects across the university that explore themes such as increasing inclusivity in the international classroom, decolonising curricula and developing sense and belonging.
Fiona Hartley (BILT/CALD) presented the ‘3 shocks’ that international students can experience:
Pedagogical (knowing what to expect academically)
Language (how to express oneself academically)
Cultural (feeling a sense of belonging and community in Bristol)
What was really interesting was the observation that some of these shocks may not be unique to international students, and indeed may be familiar to others in the wider student population, particularly first-year students.
We discussed in small groups how different schools use effective interventions and ways to enhance teaching and learning experience within and outside of the classroom. There were so many great examples, such as:
optional induction modules
allocating groups and facilitating group work sensitively
Through sharing experiences across the whole university and across disciplines, it gave us ideas on how we can implement some of these strategies in our own practices.
All in all, I really enjoyed the session; it was such an enriching discussion and I got to know many people outside of the medical school.
Dr Liang-Fong Wong is one of the University of Bristol’s Associate Pro-Vice Chancellors for Internationalisation as well as working as an Associate Professor in regenerative medicine. She also works with the undergraduate students as the Year 4 co-lead for the medical programme and is one of the inaugural members of the BMERG committee.
Welcome back to teaching and the start of 2024! In our first blog of the new year, we wanted to take a moment to reflect and celebrate how far BMERG has come since launching just six months ago.
We our hugely proud of the work that staff and students have put into this so far with:
36 blogs
6 staff profiles
4 publishing workshops
3 online writing retreats
3 journal clubs
1 external speaker
Our blogs have been viewed more than 800 times, with over 500 visitors from across the globe.
Looking forward into 2024 we can’t wait to share more blogs with you all on education research, teaching innovation, publishing, events, and much more. Make sure to subscribe to this blog to get all the latest from BMERG!
We would also love to feature more Bristol staff and students as blog writers so if you would like to contribute to the site please get in touch with the co-leads Sarah Allsop (sarah.allsop@bristol.ac.uk) and Steve Jennings (steve.jennings@bristol.ac.uk), or our shared mailbox at brms-bmerg@bristol.ac.uk.
For the first in our new ‘In conversation with‘ Series*, our BMERG co-chair Dr Sarah Allsop invited Dr Megan Brown to join BMERG for an online webinar to share her experience as an educator. Here we share some of the topics from the discussion and Megan’s top tips for embracing potential in medical education research.
We started the conversation talking about career journeys. Megan shared her own journey into Medical Education, starting in a clinical role as a doctor, and moving through a PGCert in Medical Education and then a PhD, before continuing on to research associate roles. She described her journey as feeling initially ‘pick and mix’ or serendipitous, a sense that many of us in the medical education discipline have come to know and feel, but that actually every experience has things we can take away, things we can learn, and can ultimately shape who we are and what we do.
She talked of how the different aspects of her work, whether on identity, equality or creativity, have all come together to create an interesting portfolio of work about how we look at practices within medical education, and how this translates to workforce issues like wellbeing and staff retention.
Top Tip: Consider not only your current research project, but the body or programme of research that you are doing and how this fits together. All of us need to consider what our story is: what matters to us, what impact we want to have and ultimately what we want to be known for.
Megan also talked about the way in which networking, both in person and social media has been influential in her making connections. Social media can be a really helpful way to get exposure both to others in the discipline and exposure for your own work, but the drawback is it takes time and energy.
The landscape in social media is also changing and is not for everyone. Megan encouraged us that whilst networking is important and can help to make connections that open doors, this can be done in a number of different ways, via emails, list servers, meetings and conferences to name just a few.
She also impressed on us not to get tied up in hierarchy. It is really important to connect with your peers in the discipline; those much further ahead may be really interesting to talk to, but these conversations may not yield collaborations.
Top Tip: Connect with those peers who show similar interests, and ambition to create impact in the same area as you. We are stronger when we work together.
We then talked about publishing and if Megan had any advice for those wanting to publish their work. She started with the advice to think about impact and outputs early on the the research process. All research is done to try to solve a problem, uncover truths or to empower change for the better, and so will usually have an important audience. By thinking about who might want or need to know about your results in order to influence the change you want to see, you can think about which journal, book or other medium is the best place for your work. We also talked a little about the publishing ‘game’ and the inevitable rejection that comes with trying to disseminate our work, and not to get put off by this.
Top Tip: Think broadly about how and where to disseminate your work and how to make it translatable to others. It’s not just empirical research that can be shared through publication, but commentaries, innovations, evaluation and methods, so make sure to consider carefully the best match for your work.
Finally we talked a little about role models, and Megan shared that whilst she thinks her mentors have been really important for supporting her in her career goals, she does not really have specific role models. She explained that as she is not trying to replicate another individual, she takes inspiration from wide sources, both people and environments, and through her own creativity. This has inspired her to use creative methods within her research and led to a project using poetic enquiry, “Thoughts that breathe, and words that burn: poetic inquiry within health professions education“.
Top Tip: Take inspiration from everywhere, and don’t be afraid to try new things and look for ideas outside medical education to drive new and exciting innovation.
Part of Megan’s work is being involved with the NIHR Incubator for Clinical Education Research. The Incubator’s mission is support and promote careers in clinical education research and build a multi-professional community of practice in this space, including offering free events for educators.
The next free online event and discussion, “Getting Started In … coming up with an idea and writing a research question” will be held 12.45-1.45pm Wednesday December 20th, 2023. You can sign up for this webinar and others here.
Guest Speaker Biography
Dr Megan Brown (she/her) is a Senior Research Associate in Medical Education at Newcastle University, Director of Communications and Social Media at ASME, Co-chair for Dissemination at the NIHR Incubator for Clinical Education Research, and Vice-chair of the MedEd Collaborative.Megan trained as a doctor but made the transition to full-time academic practice. Megan’s research focuses on translating and applying educational theory to practice; workforce issues within the NHS; creative approaches to research; and EDI, particularly relating to improving the support and experiences of disabled healthcare professionals, as Megan is a disabled, and neurodivergent academic herself.
* BMERG ‘In conversation with’ Series. This series of events will bring some amazing speakers to speak and share their experiences in medical education and research. Please note some sessions are only accessible to University of Bristol Staff and Students.
In BMERG’s latest report from 2023 conferences, Dr David Hettle reviews the Developing Medical Educators Group (DMEG) Annual Conference which was held online in October 2023.
The DMEG* conference provides a great opportunity for early-years educators (students, CTFs, or anyone else beginning their medical education journey) to meet others, feel inspired by a conference and presenters looking out for those at the early stage of their educator career and hear about the work of the Academy of Medical Educators and its Developing Medical Educators’ Group.
This year, the DMEG Annual Conference 2023 once again took place online, to promote access to such a conference to developing educators from across the UK and further afield. While the conference’s focus is primarily at developing medical educators and those in parallel training (medical, dental, veterinary or other healthcare science), everyone in medical education continues to develop and so there was something for everybody.
This year, keynote speakers included Dr Phil Xiu and Dr Linda Prescott-Clements, sharing their stories and journeys through healthcare education They inspired attendees to consider their next steps and all the different avenues to pursue this through, as well as recognising that medical educators are the “bridge between skill and passion” in delivering education to students, colleagues and patients.
There were also a number of excellent workshops, focussing on multiple aspects of medical education, such as clinical education scholarship, tips and tricks of teaching critical appraisal as well as developing and delivering workshops, and considering developing your career as a medical educator. View the DMEG 2023 conference programme here and the DMEG 2023 abstract book here.
DMEG also hosts both oral presentations and video pitches during their conferences, sharing novel work and innovations from participating medical educators. This year, the University of Bristol was well represented.
Last year’s University of Bristol lead Clinical Teaching Fellows (CTFs) Dr Alice Middleton (in collaboration Dr Gabriella Agathangelou), gave an oral presentation discussing their new role as lead CTFs and the wins and challenges of building a community of practice amongst CTFs, ‘Herding Cats’. They were highly commended in the oral presentation category.
Former Clinical Teaching Fellows, Dr Jacqueline Roy and Dr Tirion Swart from the North Bristol University of Bristol Teaching Academy were awarded first prize in the Video Pitch category for their work on development of a podcast to support clinical years’ medical student learning on ‘Geri-Pods’, using Podcasts to Broaden Learning on the MDT’s Role in Practice for Medical Students. You can view Jacky and Tirion’s winning pitch on Twitter(X).
Screenshot from Jacky and Tirion’s DMEG video pitch presentation
Well done to Alice, Gabby, Jacky and Tirion!
It is expected that DMEG 2024 will again be hosted online, and would be a great opportunity for anyone from the University of Bristol or further afield to meet with other beginning educators looking out for what they’re interested in, seeing what is out there in medical education and look to meet some like-minded individuals from across the world. It is anticipated that the conference will be held early October next year again, but keep an eye on the links above nearer to the time for information and abstract calls.
* The Developing Medical Educators Group (DMEG) is a subgroup of the Academy of Medical Educators and aims to promote the development of early career educators including doctors, medical students, dentists, physician associates and veterinary educators. It is open to all early career educators who are Student, Associate or Full Members of AoME.
