Co-Production at the Strategic Level: Co-Designing an Integrated Care System with Lay Partners in North West London, England.

In North West London, health and social care leaders decided to design a system of integrated care with the aim of improving the quality of care and supporting people to maintain independence and participation in their community. Patients and carers, known as 'lay partners,' were to be equal partners in co-production of the system. Lay partners were recruited by sending a role profile to health, social care and voluntary organisations and requesting nominations.

Sequential Simulation (SqS): an innovative approach to educating GP receptionists about integrated care via a patient journey--a mixed methods approach.

Background: An evaluation of an effective and engaging intervention for educating general practice (GP) receptionists about integrated care and the importance of their role within the whole system was conducted.

Methods: Workshops took place in North West London, one of England's 14 'Integrated Care Pioneers.' Three training days featuring Sequential Simulations (SqS) were held.

The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors.

Background: Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude).

The feasibility and acceptability of integrating regular centralised laboratory-based skills training into a surgical training programme.

Background: Traditional laboratory-based skills training provides mass training that does not match clinical experience and is not tailored to individual needs. This compromises the transfer and retention of skills into clinical practice.

Aim: To demonstrate the feasibility of integrating a centralised programme of laboratory-based surgical skills training into a higher surgical training programme and to evaluate its effectiveness and acceptability to trainees.

Engaging patients, users and carers in integrated care.

Engaging patients, users and carers is an important enabler of integrated care. We describe how the Inner North West London Integrated Care Pilot set up a Patients, Users and Carers Committee, found volunteers to join it, and and helped to prepare them for their role. Representatives from the group were included in the membership of the Pilot's management board and committees and took part in several engagement and educational events.

Educating for integrated care.

In September 2012 the North West London Integrated Care Plot held a conference for clinical educators. The aim was to reach a consensus about what learning clinical staff needed in order to contribute to an integrated care system. The conference was attended by 81 clinical educators from a range of backgrounds.

Vocation and avocation: leisure activities correlate with professional engagement, but not burnout, in a cross-sectional survey of UK doctors.

Background: Sir William Osler suggested in 1899 that avocations (leisure activities) in doctors are related to an increased sense of vocation (professional engagement) and a decreased level of burnout. This study evaluated those claims in a large group of doctors practicing in the UK while taking into account a wide range of background variables.

Methods: A follow-up questionnaire was sent to 4,457 UK-qualified doctors who had been included in four previous studies of medical school selection and training, beginning in 1980, 1985, 1990 and 1989/1991.

Investing in learning and training refugee doctors.

Background: Medically qualified refugees seek to build a new life and return to clinical medicine. The National Health Service (NHS) in the UK needs to develop a workforce to meet the needs of the communities it serves, and refugee doctors have the potential to contribute to the NHS, using their experience and skills to benefit patients.

Methods: Fifty-four per cent of refugee doctors in the UK live in London, so in response, the London Deanery (Postgraduate Department of Medical and Dental Education, London University) has undertaken a series of initiatives over the past 8 years assisting refugee doctors back into medical employment.

Identification and management of the underperforming surgical trainee.

Most surgical trainee make steady progress, delivering a safe and reliable service at an appropriate level at the same time as they as learn new skills under supervision. Trainees learn at different rates, and progress that is safe and steady although slower than the norm should not be classed as underperformance. Clinical performance issues may arise at any stage of a doctor's cancer, and should be addressed promptly and constructively.

A successful initiative for getting refugee doctors back into medical employment: the PRIME project.

Refugee doctors find it difficult to get back to medical work in their new countries. This article describes the setting up and evaluation of the Placing Refugee doctors In Medical Employment (PRIME) project which resulted in 15 out of 25 participants getting substantive jobs in open competition within a year, and suggests this approach should be more widely adopted.

Early signs of the trainee in difficulty.

A series of high-profile medical scandals and tragedies has generated increasing interest in the earlier detection of doctors whose health, conduct or performance may pose a risk to themselves or others. The earliest signs of problems often emerge during the training years, when it may be possible to take remedial action to prevent the doctor derailing. This article describes the early signs that have identified doctors in difficulty in a large postgraduate deanery.

Specialist registrar training: what still needs to be improved?

It is 6 years since specialist training in the UK was radically reformed. Is educational quality still improving or have early improvements slipped as the novelty has worn off? What further improvements are needed to ensure the production of specialists who are properly prepared to be the consultants of the future? The authors address these questions from the perspective of one postgraduate deanery.

Women in medicine: a four-nation comparison.

Objectives: to determine the impact of increasing numbers of women in medicine on the physician work force in Australia, Canada, England, and the United States.

Methods: We collected data on physician work force issues from professional organizations and government agencies in each of the 4 nations.

Results: Women now make up nearly half of all medical students in all 4 countries and 20% to 30% of all practicing physicians.