The drive to quality-manage medical education has created a need for valid measurement instruments. Validity evidence includes the theoretical and contextual origin of items, choice of response processes, internal structure, and interrelationship of a measure’s variables. This research set out to explore the validity and potential utility of an 11-item measurement instrument, whose theoretical and empirical origins were in an Experience Based Learning model of how medical students learn in communities of practice (COPs), and whose contextual origins were in a community-oriented, horizontally integrated, undergraduate medical programme. The objectives were to examine the psychometric properties of the scale in both hospital and community COPs and provide validity evidence to support using it to measure the quality of placements. The instrument was administered twice to students learning in both hospital and community placements and analysed using exploratory factor analysis and a generalizability analysis. 754 of a possible 902 questionnaires were returned (84% response rate), representing 168 placements. Eight items loaded onto two factors, which accounted for 78% of variance in the hospital data and 82% of variance in the community data. One factor was the placement learning environment, whose five constituent items were how learners were received at the start of the placement, people’s supportiveness, and the quality of organisation, leadership, and facilities. The other factor represented the quality of training—instruction in skills, observing students performing skills, and providing students with feedback. Alpha coefficients ranged between 0.89 and 0.93 and there were no redundant or ambiguous items. Generalisability analysis showed that between 7 and 11 raters would be needed to achieve acceptable reliability. There is validity evidence to support using the simple 8-item, mixed methods Manchester Clinical Placement Index to measure key conditions for undergraduate medical students’ experience based learning: the quality of the learning environment and the training provided within it. Its conceptual orientation is towards Communities of Practice, which is a dominant contemporary theory in undergraduate medical education.

"Curricula-in-action" generally differ from "official" curricula. That is particularly true of clerkship curricula because the practising doctors who supervise medical students' clinical activities are only secondarily educators. Clerkship education is evaluated, however, according to benchmarks set by official curricula. As a result, clerkship evaluations are important points of contact between clinical teachers and medical schools. We reasoned that an evaluation instrument is part of a medical school's official curriculum discourse and clinical teachers' reactions to it are a discourse of curriculum-in-action. We set out to answer the questions: What are clinical teachers' discourses of curriculum-in-action and how do they relate to an official curriculum discourse? Nineteen clerkship placement leads from two hospitals contributing to a single undergraduate medical programme participated. The evaluation instrument was the Manchester Clinical Placement Index, for which validity evidence has been published. Respondents were asked to say how they would react to junior students giving their placements low or high scores for each of 12 items from the Index. After transcription, we conducted a critical discourse analysis (CDA) of their audio-recorded answers. We purposefully selected the six items that elicited the widest spectrum of responses for analysis because quantity of material can compromise the quality of CDA. A dominant discourse of curriculum-in-action defined how teachers should "really" teach and junior students should learn. It deconstructed the need for teachers to be present when students performed clinical tasks because teachers' role was to give critical feedback on case presentations that were coincidental to clinical care. It positioned students at the bottom of a power hierarchy so they had to "struggle" to be taught. It placed respondents in a powerful position relative to "the hospital" and "the university", though there were tensions between respondents, patients, and nurses. Respondents dismissed criticism that was invalid according to their curriculum-in-action, which included most items in an evaluation instrument. There was a contrasting, non-dominant discourse of responding reflectively to feedback, which generated realistic ways of improving students' learning. The strength of respondents' emotions shows just how committed doctors are to students' learning. The strength of their expressions of power, however, explains why many of them teach in their own way rather than according to official curricula. Changes to clinical curricula, our findings suggest, will not be successful unless they are carefully negotiated with practising doctors.

Background Guidelines recommend that clinicians should make brief opportunistic behavioural interventions to patients who are obese to increase the uptake of effective weight loss programmes. The objective was to assess the effect of this policy on socioeconomic equity. Methods One thousand eight hundred eighty-two consecutively attending patients with obesity and who were not seeking support for weight loss from their GP were enrolled in a trial. Towards the end of each consultation, GPs randomly assigned participants to one of two 30-s interventions. In the active intervention (support arm), the GP offered referral to a weight management group. In the control intervention (advice arm), the GP advised the patient that their health would benefit from weight loss. Agreement to attend a behavioural weight loss programme, attendance at the programme and weight loss at 12 months were analysed by socioeconomic status, measured by postcode using the Index of Multiple Deprivation (IMD). Results Mean weight loss was 2.43 kg (sd 6.49) in the support group and 1.04 kg (sd 5.50) for the advice only group, but these effects were moderated by IMD ( p = 0.039 for the interaction). In the support arm, weight loss was greater in higher socioeconomic groups. Participants from lower socioeconomic backgrounds were more likely to accept the offer and equally likely to attend a weight loss referral but attended fewer sessions. Adjusting for these sequentially reduced the gradient for the association of socioeconomic status with weight loss from + 0.035 to − 0.001 kg/IMD point. In the advice only arm, 10% took effective action to promote weight loss. The decision to seek support for weight loss outside of the trial did not differ by socioeconomic status, but weight loss among deprived participants who used external support was greater than among more affluent participants ( p = 0.025). Conclusion Participants’ responses to GPs’ brief opportunistic interventions to promote weight loss differed by socioeconomic status and trial arm. In the support arm, more deprived people lost less weight because they attended fewer sessions at the programme. In the advice arm, more deprived people who sought and paid for support for weight loss themselves lost more weight than more affluent people who sought support. Trial registration This trial is registered with the ISRCTN registry, number ISRCTN26563137 . Date of registration: January 3, 2013; date of first participant recruited: June 4, 2014 Electronic supplementary material The online version of this article (10.1186/s12916-019-1284-y) contains supplementary material, which is available to authorized users.

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The issue of the teaching of transferable skills in UK higher education was set high on the educational agenda by the Dearing Report. The present study is part of a larger-scale project concerned with the development and assessment of groupworking skills through involving employers. It attempts to measure changes in groupworking skills and knowledge. Changes in groups receiving and not receiving employer feedback are compared. Results suggest that the two ways of measuring groupworking skills that were used in the study appear to be measuring different things. The experience of working on a group project appears to increase students' self-rating of their skills, in particular in problem-solving, communication and social relationship skills. Teams with a good knowledge of team processes appear to obtain high marks on the project reports, but do not rate themselves more highly on their skills.