We aim to help students develop positive coping mechanisms, promoting empathy, self-awareness and wellbeing 330

Background UK migrants born in intermediate to high prevalence areas for blood borne viruses (BBV) including hepatitis B, hepatitis C and HIV are at increased risk of these infections. National guidance from Public Health England (PHE) and National Institute for Health and Care Excellence (NICE) recommends primary care test this population to increase diagnoses and treatment. We aimed to investigate primary care professionals’ knowledge of entitlements, and perceptions of barriers, for migrants accessing healthcare, and their policies, and reported practices and influences on provision of BBV testing in migrants. Methods A pre-piloted questionnaire was distributed between October 2017 and January 2018 to primary care professionals attending the Royal College of General Practitioners and Best Practice in Primary Care conferences, via a link in PHE Vaccine Updates and through professional networks. Survey results were analysed to give descriptive statistics, and responses by respondent characteristics: profession, region, practice size, and frequency of seeing migrant patients. Responses were considered on a per question basis with response rates for each question presented with the results. Results Four hundred fourteen questionnaires were returned with responses varying by question, representing an estimated 5.7% of English GP practices overall. Only 14% of respondents’ practices systematically identified migrant patients for testing. Universal opt-out testing was offered to newly registering migrant patients by 18% of respondents for hepatitis B, 17% for hepatitis C and 21% for HIV. Knowledge of healthcare entitlements varied; fewer clinical staff knew that general practice consultations were free to all migrants (76%) than for urgent care (88%). Performance payment structure (76%) had the greatest reported influence on testing, followed by PHE and Clinical Commissioning Group recommendations (73% each). Language and culture were perceived to be the biggest barriers to accessing care. Conclusions BBV testing for migrant patients in primary care is usually ad hoc, which is likely to lead to testing opportunities being missed. Knowledge of migrants’ entitlements to healthcare varies and could affect access to care. Interventions to improve professional awareness and identification of migrant patients requiring BBV testing are needed to reduce the undiagnosed and untreated burden of BBVs in this vulnerable population.

assessing residents' interpersonal and communication skills in asthma cases. Why the idea was necessary Child or adolescent SPs have been used increasingly in the assessment of residents' clinical skills. However, no prior studies have evaluated the reliability of adolescent SPs in assessing the interpersonal and communication skills of residents in cases of asthma. Several prior studies have raised the question of whether SPs can assess interpersonal and communication skills as reliably and validly as faculty members. Resolving this question is extremely important in view of increasing clinical demands on faculty time. Thus, we decided to examine adolescent SPs' reliability in assessing residents' interpersonal and communication skills in asthma. What was done We conducted a prospective criterion standard study at a major academic medical centre. Twelve adolescent SPs were trained to rate residents' interpersonal and communication skills in a scenario involving a patient with asthma. A cohort of paediatric residents (n ¼ 18) interviewed the SPs. All interviews were directly observed by 2 trained faculty members. The SPs and faculty stuff completed identical checklists immediately following the encounter and were blinded to each others' ratings. The checklist items were adapted from the National Heart, Lung and Blood Institute Guidelines for the Diagnosis and Management of Asthma. Faculty ratings were used as the criterion standard. To validate SP ratings, we made comparisons between faculty and SP ratings. We assessed inter-rater reliability by determining the percentage of agreement, Kendall tau-b coefficient of concordance, and Cohen's kappa coefficient of correlation. Evaluation of results and impact Overall, 36 resident-SP interactions were analysed. There was a statistically significant high level of correlation between faculty and SP ratings in all areas of the interpersonal and communication skills assessed, including in terms of questions asked and information provided by the residents. Examples of statements from the checklists and their corresponding results for inter-rater reliability measures are as follows:• ÔThe doctor explained things clearlyÕ (percentage agreement 100%, Kendall tau-b coefficient ¼ 1.00, kappa ¼ 1.00; P < 0.0001); • ÔThe doctor asked about asthma medicationsÕ (percentage agreement 100%, Kendall tau-b coefficient ¼ 1.00, kappa ¼ 1.00; P < 0.0001); • ÔThe doctor asked about asthma triggersÕ (percentage agreement 94%, Kendall tau-b coefficient ¼ 0.89, kappa ¼ 0.89; P < 0.0001); • ÔThe doctor provided education about asthmaÕ (percentage agreement 94%, Kendall tau-b coefficient ¼ 0.86, kappa ¼ 0.85; P ¼ 0.002); • ÔThe doctor asked about night-time symptomsÕ (percentage agreement 89%, Kendall tau-b coefficient ¼ 0.66, kappa ¼ 0.64; P ¼ 0.005), and • ÔThe doctor asked about my feelings of having asthmaÕ (percentage agreement 83%, Kendall tau-b coefficient ¼ 0.71, kappa ¼ 0.68; P < 0.0001).The results of this study provide evidence that support the use of adolescent SPs in the assessment ...

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Background Those setting objective structured clinical exams (OSCEs) are likely to encounter candidates who dispute the examiners’ scores and feedback. At our own institution, candidates have requested video recording to aid in later academic appeals. Before ceding to such requests, we wished to be certain that the marking of recorded OSCEs would give comparable results to live marking, and that technical challenges could be met within reasonable cost. Methods We adopted a mixed‐methods approach to explore the use of video recording OSCEs. Following an initial literature review, we surveyed and interviewed the assessment leads of UK medical schools and postgraduate institutions setting high stakes OSCEs to explore their views and experience in using recordings as part of summative OSCE assessments. Results Results from our literature review reveal inconsistent findings about the comparability of marks awarded from video marking and those awarded by examiner in‐station marking, with suggestions that video marking generates lower scores. The majority of UK medical education institutions were neither videoing OSCEs nor considering doing so. Many logistical and assessor‐related drawbacks to video review were identified, with significant concerns raised about how such a process could be feasibly managed. Discussion Although the videoing of OSCEs may superficially appear an easy solution to provide defensibility of the process, the potential use is beset with challenge, going beyond purely logistical and technical difficulties. The use of videoing for the purpose of OSCE appeals is not currently supported by the literature, nor by the majority of UK undergraduate and postgraduate medical education institutions delivering high‐stakes summative OSCEs.