NIHR In Practice Fellowship Dr Aarti Bansal

Project Description

The fellowship will fund a training path towards my goal of becoming a Professor of Medical Education Research. This fellowship will provide me with the research methods training; the theoretical, methodological and conceptual understanding I need to undertake complex intervention research; and the empirical data needed to design a successful doctoral application. My anticipated doctoral work will describe the co-production and feasibility testing of a new medical education (complex) intervention to support the development of a person-centred approach to clinical practice. I will initially develop this for International Medical Graduates (IMGs), but plan to test and refine the intervention in wider groups.

Why this work is important: The UK needs a generalist workforce (experts in person-centred care), with the skills to deliver safe and effective patient care in the context of increasing long-term conditions, complexity and multimorbidity (GMC, 2013). We know that current models of professional education are part of the barriers to delivery of generalist care (Reeve et al., 2013, 2017). So how can we update our educational interventions to revitalise generalist practice? Two theoretical concepts may help us with this question: value congruence and threshold concepts. The Health Foundation notes that for educational interventions on person-centred care to be successful, the 'participants need to have internalised the ideas and so change their behaviour because they believe it is the right thing to do, not because they have been directed' (Summit Report, 2012). This is aligned with the concept of value congruence; the extent to which an individual's behaviour is consistent with a value. Threshold concepts, which exist in all disciplines, are concepts that once understood are integrative and transformative, opening up 'new and previously inaccessible way of thinking about something' (Meyer & Land, 2005). A recent study suggests that person-centred care may be a threshold concept (Neve et al., 2016). An initial evaluation of a course I delivered for IMGs in the Yorkshire and Humber Deanery suggests that exploring the value and values of person-centred care may have a transformative effect on participants' clinical practice. I therefore hypothesise that there may be educational solutions to the problem of developing a generalist workforce. I recognise IMGs as a ‘critical group’ (Giddens, 1979) within which to study this.