Background: Medical students are expected to know how to function on hospital wards and to be at ease within the ward environment. Such ward-based knowledge indicates that a student is 'ward smart'. However, formal teaching in this area seems to be somewhat neglected, with students being le to gather this knowledge through experience. Methods: Data were collected via an online questionnaire comprising both closed and open questions designed to assess students' ward smarts, focusing on knowledge of the ward environment (routines, equipment, and terminology used), relevant clinical knowledge, and communication/roles of other members of the multidisciplinary team. Multiple regression was used to identify factors in uencing students' scores (i.e. demographics, work experience). Thematic analysis was used to explore medical students' opinions on how their ward understanding could be improved. Results: In our sample of 53 medical students, 96% did not know how to turn on a hearing aid and only 30% knew what a Waterlow score was. Furthermore, 89% did not know how to read an oxygen owmeter, and only 55% knew where the CPR lever on the bed was situated. Multiple regression showed that ward smarts can be predicted by previous hospitalbased work and year group, both of which may represent time spent on wards. Thematic analysis suggested that students felt they would bene t from more ward time and shadowing healthcare professionals on the wards. Discussion: This suggests that students may not be prepared to work in a ward environment. We propose, based on training implemented in other medical schools, that a speci c ward-based interprofessional learning placement or experience should be added to the medical curriculum. As an initial step, speci c teaching and/or practical sessions for students centred around patient communication and understanding the ward environment would be bene cial.

Introduction Updated guidelines published by the National Institute for Health and Care Excellence in 2015 widened the referral criteria for the two week wait (2WW) pathway for suspected lower gastrointestinal cancer, in an attempt to increase early diagnosis. The aim of this study was to evaluate the compliance of referrals received via the (2WW) pathway for suspected lower gastrointestinal cancer. Method We conducted a retrospective study which utilised a local cancer registry to identify all patients who had been referred to United Lincolnshire Hospitals Trust over a two-month period. Electronic patient records were checked to establish whether patients fulfilled the 2015 referral criteria. Results Out of 615 patients referred, 51 (8%) had colorectal cancer. 92 (15%) referrals did not meet the criteria for the 2WW pathway. Whether or not the referral was ‘appropriate’ had no significant effect on the diagnoses of bowel cancer (X2 = .003, p>.05). Conclusions 16% of all referrals did not meet criteria. This may appear as an inefficient use of resources, however there was no difference in rates of cancer between appropriate and inappropriate referrals. The referral criteria are likely to evolve over the course of time, and perhaps clinicians’ judgement should be taken into account.

Background Despite growing recognition of essential human rights, people with mental health conditions and psychosocial, intellectual, or cognitive disabilities’ rights are known to be frequently violated in mental healthcare worldwide, with common use of coercive practices and limited recognition of people’s right to exercise their legal capacity and make decisions for themselves on treatment and other issues affecting them. To tackle this issue, Ghana adopted the WHO QualityRights Initiative in 2019. This aims to introduce a right-based, person-centred recovery approach within the mental health care system, protecting and promoting the rights of people with mental health conditions, psychosocial, cognitive, and intellectual disabilities in the healthcare context and community. Methods E-training (capacity-building) was provided in Ghana across a broad array of stakeholder groups including healthcare professionals, carers, and people with lived experience. The training covered legal capacity, coercion, community inclusion, recovery approach, service environment, and the negative attitudes commonly held by stakeholder groups; it was completed by 17,000 people in Ghana as of December 2021. We assessed the impact of the e-training on attitudes through comparing trainees’ pre- and post-questionnaire responses on 17 items, each measured on a 5-point Likert scale (strongly disagree to strongly agree), such that higher scores indicated negative attitudes towards persons with mental health conditions and psychosocial disabilities as rights holders. Analyses were conducted on two main groups: matched pairs (417 pairs of baseline and follow-up questionnaire responses matched to a high degree of certainty), and the unmatched group (4299 individual completed questionnaire responses). Results We assessed the impact of the WHO QualityRights e-training on attitudes: training resulted in highly significant attitude changes towards alignment with human rights, with scores changing by approximately 40% between baseline and follow-up. In particular, attitude changes were seen in items representing treatment choice, legal capacity, and coercion. This change was not affected by age, gender, or background experience. Conclusions The QualityRights e-training programme is effective in changing people’s (especially healthcare professionals’) attitudes towards people with mental health conditions and psychosocial, intellectual, or cognitive disabilities: this is a step towards mental healthcare being more with human rights-based worldwide.

BackgroundMedical students are expected to know how to function on hospital wards and to be at ease within the ward environment. Such ward-based knowledge indicates that a student is ‘ward smart’: levels of ward smarts vary between students (e.g. based on prior work experience and opportunities offered by placements). However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along, which can have an impact on their clinical education. MethodsData were collected via an online questionnaire comprising both closed and open questions designed to assess students’ ward smarts, focusing on knowledge of the ward environment (routines, equipment, and terminology used), relevant clinical knowledge, and communication/roles of other members of the multi-disciplinary team. Multiple regression was used to identify factors influencing students’ scores (i.e. demographics, work experience). Thematic analysis was used to explore medical students’ opinions on how their ward understanding could be improved.ResultsIn our sample of 53 medical students, 96% did not know how to turn on a hearing aid and only 31% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 57% knew where the CPR lever on the bed was situated.Multiple regression showed that ward smarts can be predicted by previous hospital-based work and year group, both of which may represent time spent on wards. Thematic analysis suggested that students felt their understanding of wards would benefit from more ward time and shadowing allied healthcare professionals on the wards.ConclusionsThis suggests that students may not be prepared to work in a ward environment. We propose, based on training implemented in other medical schools, that a specific ward-based interprofessional learning placement or experience should be added to the medical curriculum. As an initial step, specific teaching and/or practical sessions for students centred around patient communication and understanding the ward environment would be beneficial.

Background Effective non-technical skills can reduce healthcare error1, including the use of decision making tools (cognitive aids2) and communication in raising concerns3. A local survey suggested that 81% of medical students would use cognitive aids in decision making and 78% would raise concerns with a senior. This study considered whether students actually did so in simulated scenarios and to what extent this was affected by teaching interventions. Methodology Final year medical students were observed during three high-fidelity cardiac arrest scenarios. Behaviour coding frames with a checklist of behaviours, developed through observations of previous scenarios, were used to assess use of the ALS algorithm and the ability to raise concerns when given incorrect advice. A one-way between groups design was used to investigate the effect of presentations, with Group A taught about both the use of cognitive aids and the process of raising concerns, Group B about cognitive aids only and Group C about raising concerns only. Results Cognitive Aid: Eleven scenarios were observed by a faculty member using the behaviour coding frame. In no scenario was the cognitive aid physically used; only Group B mentioned the ALS algorithm. However the behaviours on the algorithm were still present; Group B completed the specified behaviours most often and in better time. Raising concerns Conclusions and recommendations Findings suggest that despite students often stating that they would use physical cognitive aids and raise concerns, the reality (despite simulated) does not meet their belief. These findings, however, do suggest that an educational intervention improves performance. Such interventions could therefore improve safety behaviours with the eventual aim of reducing error rates. References Flin R. (2013) Non-technical skills for anaesthetists, surgeons and scrub practitioners (ANTS, NOTSS and SPLINTS). The Health Foundation Harrison T, Mansa T, Howard S, GABA D (2006). Use of cognitive aids in a simulated anaesthetic crisis. Anaesthesia and Analgesia. 103. pp 551–6 White AA, Bell SK, Krauss MJ, et al, (2011). How trainees would disclose medical errors: educational implications for training programmes. Medical Education. 2011;45 (4):372–80