Background: The learning environment impacts many aspects of healthcare education, including student outcomes. Rather than being a single and fixed phenomenon, it is made up of multiple micro learning environments. The standard clinical learning environment measurement tools do not consider such diversity and may fail to adequately capture micro learning environments. Moreover, the existing tools are often long and may take a prohibitive amount of time to complete properly. This may have a negative impact on their usefulness in educational improvement strategies. In addition, there is no universal tool available which could be utilised across several healthcare student groups and placement settings. Aim: To create an evidence-based measurement tool for assessing clinical micro learning environments across several healthcare profession student groups. Methods: The measurement tool was developed through a step-wise approach: 1) literature review with iterative analysis of existing tools; 2) generation of new items via thematic analysis of student experiences; 3) a Delphi process involving healthcare educators; 4) piloting of the prototype; and 5) item reduction. Results: The literature review and experiential data from healthcare students resulted in 115 and 43 items respectively. These items were refined, leaving 75 items for the Delphi process, which produced a prototype with 57 items. This prototype was then completed by 257 students across the range of healthcare professions, with item reduction resulting in a 12-item tool. Conclusion: This paper describes a mixed methods approach to developing a brief micro learning environment measurement tool. The generated tool can be used for measuring student perceptions of clinical environments across several healthcare professions. Further cross-cultural and cross-professional validation studies are needed to support widespread use, possibly through mobile application.

Objectives: To identify and summarise health workers' views on the use of audit as a method to improve the quality of maternal and newborn healthcare in low-and middle-income countries (LMICs). Methods:We conducted a qualitative evidence synthesis. PubMed, CINAHL, and Global Health databases were searched using keywords, synonyms and MeSH headings for 'audit', 'views' and 'health workers' to find papers that used qualitative methods to explore health workers' views on audit in LMICs. Titles and abstracts were then screened for inclusion. The remaining full-text papers were then screened. The final included papers were quality assessed using the Critical Appraisal Skills Programme tool for qualitative research. Data on audit type and health workers' perceptions were extracted and analysed using thematic synthesis.Results: 19 papers were included in the review, most from sub-Saharan Africa. Health workers generally held favourable views of audit and expressed dedication to the process. Similarly, they described positive experiences conducting audit. The main barriers to implementing audit were the presence of a blame culture, inadequate training and the lack of time and resources to conduct audit. Health workers' motivation and dedication to the audit process helped to overcome such barriers. Conclusions: Health workers are dedicated to the process of audit, but must be supported with training, leadership and adequate resources to use it. Decision-makers and technical partners supporting audit should focus on improving audit training and finding ways to conduct audit without requiring too much staff time.

Peer-assisted learning (PAL) is becoming increasingly popular within medical education, reflected by the amount of literature on the subject. There are numerous benefits of PAL for both teachers, students and faculty. At Lancaster Medical School, we decided to first investigate whether students wanted a student-led PAL society. Following the results, we set up the Lancaster University Peer-Assisted Learning Society (LUPALS) in 2013. Since its foundation, LUPALS has successfully provided over 100 teaching sessions to medical students at Lancaster Medical School. We have highlighted the important aspects of setting up our PAL society with reference to the evidence base and provided recommendations for others who are considering creating their own PAL society at their institution. We conclude that setting up LUPALS has been a successful venture and should act as encouragement for others who wish to do the same.

Objectives & BackgroundDespite the importance of children being up-to-date with routine childhood immunisations, uptake rates remain sub-optimal. Guidance from NICE and the WHO state that every contact a child has with healthcare services be thought of as an opportunity to provide catch-up immunisation. Paediatric emergency departments (PED) therefore have the potential to increase local vaccination rates.The overall aim of this work was to look at the viability of introducing opportunistic vaccination into the PED. The aim of these two audits was to look at potential barriers to such a programme.Audit 1: is vaccination status recorded in the notes of children presenting to the PED at North Manchester General Hospital (NMGH)?Audit 2: do PED staff currently deliver vaccinations in the department?MethodsAudit 1: a retrospective audit of the notes of 500 children who presented to the PED before their third birthday. Basic demographic data were recorded along with what vaccination history appeared in their notes.Audit 2: a retrospective audit of pharmacy orders for vaccines for the PED over a five and a half year period. These data were used as a proxy for how many vaccinations were administered in the PED the same time period.ResultsThe audit of vaccination status demonstrated that only 28% of attendees had their vaccination status recorded, but 93% of these were up-to-date with their vaccinations to an age-appropriate level.The audit of paediatric vaccinations demonstrated that across the 66 month period, 75 vaccinations were ordered.This work suggests vaccination status is not well recorded in the PED. In the absence of access to centrally-held vaccination records, this may prevent introduction of a successful programme. Additionally, it appears that only a small number of vaccinations are currently given in the department, suggesting that there may not be sufficient existing vaccination expertise.ConclusionWhilst these findings do not support the introduction of opportunistic vaccination to provide catch-up for routine childhood immunisations, this approach deserves further exploration and future work could look at signposting children back to primary care, rather than offering the vaccination in the department. However, it may be possible to offer other, non-routine vaccines in the PED as a way to increase local vaccination rates e.g. by offering intranasal seasonal influenza vaccination to children attending the PED.