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Introduction: The lesbian, gay, bisexual, and transgender (LGBT+) population experience health and social inequalities, including discrimination within healthcare services. There is a growing international awareness of the importance of providing healthcare professionals and students with dedicated training on LGBT+ health. Methods: We introduced a compulsory teaching programme in a large London-based medical school, including a visit from a transgender patient. Feedback was collected across four years, before (n = 433) and after (n = 541) the session. Student confidence in using appropriate terminology and performing a clinical assessment on LGBT+ people was assessed with five-point Likert scales. Fisher exact tests were used to compare the proportion responding “agree” or “strongly agree”. Results: Of the students, 95% (CI 93–97%) found the teaching useful with 97% (96–99%) finding the visitor’s input helpful. Confidence using appropriate terminology to describe sexual orientation increased from 62% (58–67%) to 93% (91–95%) (Fisher p < 0.001) and gender identity from 41% (36–46%) to 91% (88–93%) (p < 0.001). Confidence in the clinical assessment of a lesbian, gay or bisexual patient increased from 75% (71–79%) to 93% (90–95%) (p < 0.001), and of a transgender patient from 35% (31–40%) to 84% (80–87%) (p < 0.001). Discussion: This teaching programme, written and delivered in collaboration with the LGBT+ community, increases students’ confidence in using appropriate language related to sexual orientation and gender identity, and in the clinical assessment of LGBT+ patients.

Background Feedback received from medical students at University College London Medical School (UCLMS) suggested a lack of clarity regarding the contents and subsequent assessment of the undergraduate curriculum. In order to address these issues, a specialist team was established with the aim of designing and implementing a Curriculum Map (CM), which have been recognised in their ability to provide a centralised, visual representation of the curriculum. While multiple perspectives from educators to stakeholders can be considered here, the need for the CM to remain student centred was identified as key at UCLMS. The aim of this study was therefore to understand the requirements of the CM prior to production from the perspective of the medical students. Methods A mixed-methods sequential study was conducted. The first stage involved gathering quantitative data using a primary online survey. This used 15 questions, rated by Likert scales and focussed around three domains: depiction of content, functionality and students’ likely engagement with a CM. There was a free-text question for additional comments. The second stage consisted of multiple student focus groups representing different years of the programme, conducted by trained facilitators following a predetermined scheme. Reflective Thematic Analysis (RTA) was used to synthesise the qualitative data, which was read independently by two researchers. All students at UCLMS were invited to participate in the study. Results There were 409 survey responses. 92% of students said they were ‘likely’ or ‘very likely’ to use a CM, with their key intended use being to monitor their learning progress and ensure preparedness for assessments. Five key themes emerged from the focus groups, namely that students wanted a CM to be: comprehensive; simple and intuitive; able to link content throughout the course; aligned with assessment; and useful to monitor students’ progress. Conclusions Through this study, valuable insight was gained on students’ ideal preferences for the CM. Understanding this was important in order to ensure that its co-design remained student-centred prior to its design and launch. This study also highlighted the need to set realistic expectations for students on the role of a CM in preparing them for assessments, and ultimately professional practice.

We have a duty of care to our future doctors, says Faye Gishen

Background Following student feedback, a Curriculum Map (CM) was commissioned in 2018 at UCL Medical School (UCLMS). After exploring key requirements of a CM, the second phase focused on building a prototype before its launch. This study evaluates this novel pedagogical intervention following its implementation, from the perspective of its primary users, UCL medical students. Methods This multi-method study was conducted two months after the CM’s launch in 2019. Quantitative and qualitative data was gathered via a survey and focus groups across four domains: usefulness, satisfaction, appearance, and content. Reflective Thematic Analysis was used to analyse the qualitative data to build themes. Results One hundred ninety five participants (195/1347, 14%) responded to the survey and two focus groups were held. Higher rates of satisfaction were seen among later years compared to early years students. Five key themes emerged on the CM as a: UCLMS textbook; learning aid for assessments; tool for capturing scientific content; modern learning technology and tool for ‘levelling the playing field’. Key findings suggest that while students welcomed a centralised resource to create transparency, there were clear differences between early and later years students, with the former preferring a more prescriptive approach. Learning was assessment-driven across all years and students highlighted their desire for greater clarity on the importance of curricular content for summative assessments. Conclusion A CM provides a benchmark for medical educators on the undergraduate curriculum, which must be balanced with its limitations; a CM cannot provide an exhaustive syllabus and needs to be supplemented with self-directed learning and clinical preparation for practice.

Background One in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students’ opinions of this teaching and their wider attitudes towards abortion. Methods We invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests. Results One hundred and forty-six questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). Fifty-seven percent felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students’ attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life. Conclusions The majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women’s healthcare, and may contribute to destigmatising abortion.

ObjectiveThis paper examines the impact on doctors’ attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case.DesignA cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case.SettingPrimary and secondary care settings across a broad geographical spread in England.Participants474 doctors.Outcome measuresAttitudes towards the GMC and two professional behaviours in TPB dimensions.ResultsAttitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC’s disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors’ attitudes or intention to reflect or raise concerns.ConclusionsThe lack of change in doctors’ attitudes towards the GMC’s guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors’ trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors’ overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.

Background Doctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula. We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience. Methods The authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students ( n  = 363) as well as voluntary attendance focus groups ( n  = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers. Results The authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum. Conclusions More research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.

We need to evolve curriculums that are reflective of the populations we teach and serve clinically