Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the UK.

OBJECTIVE: To better understand the broader experience of medical students impacted by discrimination and the support systems they engage with. DESIGN: Qualitative study using semi-structured interviews. SETTING: Four medical schools based in the UK. PARTICIPANTS: 17 medical students were recruited using volunteer and snowball sampling: all students self-identified as being impacted by discrimination. RESULTS: 5 themes were identified: feelings of isolation, imposter syndrome and exclusion; a lack of representation and positive role modelling; the importance of peer support; issues relating to the accessibility of support; building support networks through shared experiences and attempts to foster a sense of inclusion through peer and institutionally led initiatives. CONCLUSIONS: The findings of this study suggest medical schools could do more to recognise the importance of acknowledging the multiple identities at risk of discrimination held by students, perpetuating feelings of isolation and exclusion. Our research highlights the need for practical systemic initiatives to improve the sense of belonging of medical students who are impacted by discrimination. Medical educators and institutions should consider formal and informal provisions, such as creating time and space for students to meet and share experiences, access support and reporting networks, to foster a greater sense of belonging.

Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students' longitudinal experiences in primary care.

OBJECTIVE: Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school. DESIGN: We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis. SETTING: One research-intensive medical school based in the UK. Data collection occurred in 2021-2022. PARTICIPANTS: 12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year. RESULTS: We constructed four themes capturing insights on how hidden curricula influenced students' experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning. CONCLUSIONS: The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.

A contextual definition of longitudinal integrated clerkships within the UK and Ireland: A bi-national modified Delphi study.

Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.

Psychological distress and the perceived impact of the COVID-19 pandemic on UK dentists during a national lockdown.

Introduction Dentists are known to function under stressful conditions. It is important to monitor, examine and understand the psychological effects the unprecedented challenge of the SARS-CoV-2 pandemic has had.Aims To compare levels of psychological distress in UK dentists, before and during the pandemic, to determine if this was affected.Materials and methods An online survey collected demographic data, levels of psychological distress (GP-CORE) and experiences from UK dentists during the 'national lockdown' period of the pandemic. Statistical and thematic analyses were performed and data compared with previous research.Results Psychological distress was lower in UK dentists during the national lockdown period when compared to previous research using the same measure. GDPs, those in England and those with mixed commitment reported the highest levels of psychological distress. Most dentists had been affected by the pandemic. Some who were remotely working during this time valued the time away from the profession, relishing the absence of regulatory and contractual stressors, and used lockdown as an opportunity to re-evaluate their lives and careers. Others found the conditions stressful with some previously acknowledged stressors remaining and novel stressors introduced.Conclusions We argue that the altered balance of stressors and the resulting reduced psychological distress is further evidence of the need for reform of the profession to improve working lives. Given the importance of mental health and wellbeing, it is vital that monitoring continues.

Commissioning in the community dental services: what do dentists think?

Aims This study aims to elucidate the thoughts and experiences of community dental service (CDS) dentists on procurement. Interviews were conducted and accompanied by secondary analysis of census data.Methods Demographics and working conditions were examined and interview participants discussed the tendering process.Results CDS dentists were motivated by their patients and overall enjoyed their work. Interviews identified three key themes relating to commissioning: 1) process - dentists' experience of the tendering process; 2) effects - what dentists believe their service looks like after tendering; and 3) results - how dentists believe tendering has affected patients. The point of commissioning was questioned. It was perceived to negatively affect the working environment and the care provided to patients, and was seen to cause a shift in service priorities. It was suggested that providers entered into a state of stasis during commissioning, leaving services to decay.Discussion This paper, the second in a series examining the community and public dental services, highlights the effects that commissioning has on staff and patient care, and builds on the understanding developed in the first paper of this series.Conclusions Further work is needed to examine the place of competitive commissioning in dentistry and, given its ubiquitous use, it is of importance to all dentistry stakeholders.

Stress, psychological distress, burnout and perfectionism in UK dental students.

Introduction With an emphasis on good grades and a high level of performance, studying dentistry can be stressful and may attract a greater number of students with perfectionist strivings. Prolonged stress can lead to mental ill-health, including a risk of burnout and psychological distress.Aims To examine the level and sources of stress, psychological distress and burnout in UK dental students. Perfectionism was also measured to see if dental students showed high levels of perfectionism and how this may relate to psychological outcomes. Finally, coping strategies were assessed.Materials and methods BDA student members were invited to take part in an online survey using validated measures examining stress (DES, PSS), burnout (OLBI-S), perfectionism (short APS) and coping (brief COPE) in UK dental students.Results Four hundred and twelve students from all UK dental schools completed the survey. High levels of stress, burnout and psychological distress were found, which generally increased as the course went on. Thirty-five percent of students were identified as maladaptive perfectionists and were shown to exhibit increased levels of stress, burnout and psychological distress, and a greater use of ineffective coping strategies.Conclusions Stress management needs to be taught as part of the dental education curriculum and should include information about coping strategies, as well as maladaptive perfectionism and how to address this.

The community and public dental services: a mixed-method exploration of the workforce.

Aims This exploratory study is the first in a series of two examining the working conditions of the community and public dental services in the UK to provide insight, context and understanding on their current status.Methods Secondary analysis of census data was supplemented by qualitative analysis of interview data from community and public dental service dentists. Demographic and working conditions data were examined and interview participants discussed their role, service and patients, potential service improvements and how they saw the services developing.Results Overall, dentists were satisfied with their role but did not feel secure in their job and worked more hours than they were contracted to. Interviews identified three key themes: 1) personal - aspects affecting the interviewee on a personal level; 2) patients - aspects affecting patients; and 3) service - aspects relating to the service. Services had changed and were seen, in part, to have become more efficient, but some clinicians thought the focus had moved away from patients.Conclusions Overall, clinicians enjoyed their role, but while services were seen to provide good patient care, dentists felt under pressure. Changes to general dental practice, management practices and increased funding were believed likely to improve the services.

Dental associates' perceptions of their working environment: a qualitative study.

Background The aim of this study was to explore the experiences of dental associates and how these relate to their working environment.Methods Qualitative methodology was used. Semi-structured interviews were conducted with 11 associates in the UK in early 2018. Participants were asked about their working experiences, professional autonomy and the improvements they thought could be made to their working environment. Interview transcripts were analysed using deductive thematic analysis.Results Three key themes were identified: 1) 'conditions', how associates view their working environment; 2) 'drivers', what associates believe drives their working conditions; 3) 'effects', how associates are affected by their working environment. There were differences between the working environments of associates working in corporate practice and those in independent practice. They relate primarily to decision-making and finances. While most associates enjoyed their job, a common factor that negatively affected associates was governance including the current NHS contract and actions of the General Dental Council.Discussion The results of this study indicate that associates and the profession face a variety of issues today. The effects this has on associates could contribute to the changes that are being seen in the profession and are explored using social psychology theories.Conclusion The findings of the study complement work demonstrating corporate associates to have lower levels of autonomy than their non-corporate peers and highlights that drivers vary between sectors. Social psychology theories indicate that the working environment could be affecting change in the profession.