A description and evaluation of an educational programme for North West England GP trainees who have multiple fails in the Clinical Skills Assessment (CSA).

Background and aims: Trainees who have failed the Clinical Skills Assessment (CSA) component of the Membership of the Royal College of General Practitioners (MRCGP) licensing examination present an educational challenge. This study describes a CSA resit programme and evaluates the outcomes when doctors reattempt the CSA. Methods: We delivered an educational programme to trainees in North West England who were resitting the CSA in 2016 and 2017: the majority were undertaking periods of additional training time. After the programme, we compared their CSA pass rates with national pass rates. Results were stratified by the number of previous attempts and source of primary medical qualification. Results: The trainees who took part in this programme had pass rates that exceeded national pass rates. Results were particularly encouraging for the group of International Medical Graduates (IMGs) who had previously failed the CSA two or more times. Conclusions: We suggest several possible explanations for these results. All trainees reappraised their learning needs, using educational tools written by CSA assessors. The programme was delivered by experienced, trained educators working with both trainee and trainer in order to produce shared educational plans. The training community's commitment to support trainees improved their confidence and motivation.

Performance in the MRCGP CSA by candidates' gender: differences according to curriculum area.

BACKGROUND AND AIMS: Differences in performance between male and female candidates in the CSA exam have been reported. This study aimed to consider this in more detail, looking at gender performance overall, and to check if there are particular task domains or curriculum topic areas where male and female doctors score differently. METHOD: Routinely collected data were analysed, enabling detailed comparison of gender performance across 92 989 consecutive encounters, which were examined for any overall impact of candidate gender, and sub-analysed by assessment domain, and by curriculum area. Significance of differences was calculated by analysis of variance. RESULTS: Female GP trainees outperform their male peers in the CSA overall, in each assessment domain and in every curriculum area. The difference in performance is most marked in the areas of women's health and sexual health and least marked in cardiovascular problems and rheumatology and musculoskeletal. CONCLUSIONS: These findings have implications for GP trainees and trainers when planning educational activities and opportunities. As well as prioritising the development of consultation skills, consideration needs to be given to the case mix presented to trainees, especially in light of the changing role of the doctor within practices and the composition of training programmes.

Integrin alpha9beta1 directly binds to vascular endothelial growth factor (VEGF)-A and contributes to VEGF-A-induced angiogenesis.

Vascular endothelial growth factor A (VEGF-A) is a potent inducer of angiogenesis. We now show that VEGF-A-induced adhesion and migration of human endothelial cells are dependent on the integrin alpha9beta1 and that VEGF-A is a direct ligand for this integrin. Adhesion and migration of these cells on the 165 and 121 isoforms of VEGF-A depend on cooperative input from alpha9beta1 and the cognate receptor for VEGF-A, VEGF receptor 2 (VEGF-R2). Unlike alpha3beta1or alphavbeta3 integrins, alpha9beta1 was also found to bind the 121 isoform of VEGF-A. This interaction appears to be biologically significant, because alpha9beta1-blocking antibody dramatically and specifically inhibited angiogenesis induced by VEGF-A165 or -121. Together with our previous findings that alpha9beta1 directly binds to VEGF-C and -D and contributes to lymphangiogenesis, these results identify the integrin alpha9beta1 as a potential pharmacotherapeutic target for inhibition of pathogenic angiogenesis and lymphangiogenesis.