Phronesis and the Medical Community

Lead Research Organisation: University of Birmingham
Department Name: Health Service Management Centre

Abstract

This study explores how doctors across their professional careers utilise moral resources to navigate the complex world of healthcare in an era of markets and user choice. The dual aims are first to understand the nature of phronesis (practical wisdom) transmission, interpretation and enactment by doctors through medical education and into practice and second to develop an arts based methodology to reliably frame phronesis in the institutions that participate in the study and that can be used in the study of phronesis in other professions (e.g. teachers and lawyers).

To date little research has explored the ways in which phronesis is cultivated over a period of time within one professional community. There is an absence of research with medical professionals to explore how they have accumulated and enacted phronesis within their daily practice. Questions have rarely been asked as to how professionals are equipped morally (or otherwise) to navigate a chaotic world of practice rife with competing demands and relationships. To date, many researchers within medicine have made the case for a reorientation towards phronesis in medical education, but little has been undertaken to explore what that might look like.

Existing studies have tended to capture practical wisdom within one snapshot, within one organisation or by following one practitioner. In this study three communities of doctors over three time periods will be studied: beginning of formal medical study; on placement at the end of formal study; and established medical professionals with 5 years plus qualified experience. This design will offer an opportunity to see how phronesis develops over time whilst enabling a varied discussion about how moral resources are accessed and what the role of formal education is in equipping practitioners for the messy realities of practice.

By exploring how doctors at different points in their careers have access to or draw upon moral resources, we are interested to see how they make 'good' decisions for the patient at hand; balancing care, compassion, quality, resources, capacity, medical outcomes and the wider well-being of the community. The participants will be involved in creatively shaping an original 'soap opera' style series of video clips that will connect to an existing virtual community of health and social care practitioners, patients and the public. The purpose is to engage them in providing an artistic interpretation through which they see the issues of phronesis in their practice arena. The soap opera and the way it links to the community will be debated with a broad audience of academics, practitioners, patients and policy makers and others with an interest in the field. Through this process we expect to be informed and challenged e.g. about our approach, the teaching of ethics, public engagement and public trust.

The video series will be available through the AHRC website and other mediums such as DVD and YouTube. A report, journal and conference papers will become a resource for Connected Communities researchers, medical education practitioners, wider academia and health and social care communities to utilise. The video series will offer an innovative, edgy complement to the many text based recommendations that have emanated from scandal enquiry reports and social science based studies to date.

New understandings of the cultivation of phronesis in medical communities and its role in rebuilding public trust in the light of many scandals will be of interest to healthcare researchers, educators, practitioners and policymakers. Specific value to the AHRC Connected Community programme through the arts based methodology is expected. The project aims to deliver a return on the AHRC's investment by impacting on the medical and professional education of doctors as a community, building stronger links between the medical community and the public and rebuilding public confidence in the medical profession.

Planned Impact

The main impacts will be to increase the effectiveness of health services and enhancing health and well being all within the time-frame of the research. The methodology developed will be applicable to other sectors such as care, education, law and business and therefore the research promises much wider economic benefit and competitiveness for the UK. Immediate beneficiaries include:

1. Patients - by a refocusing of clinical care on the 'good action' and the practise of professional virtues within the context of the patient at hand. Francis (2013) makes a direct link between healthcare professionals' values and patient care. Although both the GMC (2013) and Francis (2013) emphasise the importance to patient care and safety of virtues in good professional practice neither highlight the means of how to achieve phronesis and virtuous professional practice. This project will contribute to the means in order to achieve these re-stated aims and benefit patients in the process.

2. General Public - virtually all citizens of the UK receive care from doctors in the NHS and have an interest in being treated with dignity and receiving good care, which are inextricably linked with phronesis and good professional values (Good Medical Practice GMC 2013).

3. Medical Students and Doctors - by improved facilitation of the accumulation of practical ethical wisdom and appropriate guidance to develop professional values based on situational virtue. Study participants will have the scope to reflect and upon and discuss their clinical actions, implications and alternative ways of acting in a safe environment. In addition, greater patient satisfaction and outcomes which will lead to greater job satisfaction for clinicians and reduce stress levels (Corley 2001). There is evidence that doctors become psychologically compromised (Shale 2012) when the right course of action is unclear or where there are competing ethical demands and the pathway of the virtuous or good doctor is not clear.

4. Allied health care professionals - doctors acting as good role models as members of multi-disciplinary teams (typical in the provision of secondary care) will improve interaction and influence the allied health contingent within the membership. Also educational tools and good doctor role models will create the opportunity for any interacting health care professional to acquire their own practical wisdom as they emulate and copy medics in the team (Hilli et al 2013).

5. NHS - many current complaints are focused on poor or non-virtuous attitudes of staff towards patients (Health Service Ombudsman 2011). Doctors and medical students realigning their professional values to focus on virtues will improve patient experience, safety and care within the NHS. It is generally acknowledged that better care leads to better clinical outcomes and improved patient experiences (Health Service Ombudsman 2011). As a result the NHS will produce better patient outcomes and will receive fewer complaints which in turn will lead to better financial performance.
6. Medical Schools and Health Education England - by improving education of medical ethics and professional values. This would enable medical educators to be better able to meet the objectives of the requirements of the medical regulators, government and the DOH. In particular, the requirements of the GMC in 'Tomorrows Doctors', MLCF and post-graduate medical curricula will have new methods to meet the demands and definitions of good medical practice.

7. Other professional groups - this research will offer transferable learning to other equally affected sectors, particularly social care because some of the information produced and insights gained will be applicable to other professional environments and groups. This is particularly timely given the crises in public confidence about the professional values and lack of virtuous practice in banking, the media, social care, the police, etc.

Publications

10 25 50
 
Title Arts Based Safe Placement Virtual Community Creative Product 
Description Effectively a soap opera style depiction of the findings, the collective wisdom of the participants, to convey some of the stories, themes and serial of ethical decision making. The film episodes show two medical students working their way up to experienced Consultant and GP and what they encounter along the way. The virtual community product (part of Stilwell) is an alternative safe placement option for doctors in training who may not get to experience the practical challenges that their predecessors used to do. They have a chance to see ethical decision making embodied action by professional actors and then debate and discuss in a safe environment what they would do in that situation. 
Type Of Art Film/Video/Animation 
Year Produced 2018 
Impact The feedback has been that is is an adaptable virtual community resources to allow moral debate, medical practice virtue formation, cultivation of phronetic decision making and inclusion of other virtues as and when. Some of the evaluation comments so far: 'Superb as a teaching tool' 'Virtues leading to flourishing - so if I work on being virtuous in my practice I will flourish, feel I am doing good in the world etc.' 'Beauty of videos are that it shows professionals are human' 
URL https://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/res...
 
Title Wisdom Wheel and 3 Stage Process Tool 
Description A Wisdom Wheel App that contains the fifteen virtue continuums and a set of questions for each virtue. It has been developed as part of the resources to be piloted and evaluated alongside the video series. The process tool allows reflection at 3 stages to arrive at a decision using phronesis. 
Type Of Art Artistic/Creative Exhibition 
Year Produced 2018 
Impact Very strong interest (72 people) has been shown in using the App alongside the other resources derived from the findings. 
URL https://phronesis.medicloud.io
 
Description Despite having professional lives that are rife with competing demands and relationships, questions have rarely been asked about what professionals need in order to be equipped morally (or otherwise) to deal with these. The most ethically challenging decisions in any organisation are often cases in which there are multiple conflicting moral and functional goals that a leader feels bound to pursue. In the particular context of this research a medical consultant or GP must weigh up the different benefits that they can pursue for their patients - should they seek to prolong life or ease pain in the palliative care setting? The good for a particular patient must also be weighed up against the good for others - for instance, who, out of a range of suitable patients, should benefit from an organ transplant when only one organ is available. Or, when five patients require emergency operations to save life or limb, who should benefit from being at the front of the queue? Even when it is clear initially what benefit or outcome to pursue, there are often multiple ways and other influences impacting on the decision such as resources, law, etc. in which this outcome or an alternative can be reached. Is it best, for instance, to prescribe a drug, advise on nutrition, advocate surgery or allow the patient to choose? This is often further complicated by co-morbidities such as obesity, high blood pressure, high cholesterol and influences impacting on the decision such as resources, law etc.

When faced with such uncertainty, whether this be in a medical setting or otherwise, the response of many leaders is to reach for the rule-book - that is, to make ever more intricate guidelines, protocols and procedures to determine what must be done in morally fraught situations. In 1990, 73 clinical guidelines could be found in PubMed. By 2012, this had risen to 7,508; indicating a significant growth in clinical practice guidelines. However, in the face of this tide of ever-closer codification of good medical practice, many clinicians bemoan the loss of their professional autonomy with practitioners noting the inability of these guidelines to take into account the complexity of caring for patients with multiple comorbidities and complex contexts. The paradox for leaders as they govern practice today is this: whilst these rule-based mechanisms are supposed to bring clarity, accuracy and consistency to decision making and make it easy to know what to do, leaders themselves experience the growth of rules, guidelines and procedures as alienating, confusing and even demeaning. They also recognise the limitations of these guidelines: they tend to oversimplify the complexity of the clinical situation, making patients single-pathology entities rather than the complex multifaceted (medically and socially) humans that they are.


Here is an outline of the final findings from the research: as a concept phronesis (practical wisdom) can help leaders in medical and other professional contexts lead, and make decisions more ethical. Making them more ethical means decisions that not only benefit their immediate patients but the well-being of their communities and wider society. The findings as outlined below support that contribution:

1) An understanding that good and wise decision making for people who consider themselves ethical leaders goes beyond following a set of guidelines or rules or working out the consequences of their actions; but also requires the ability to discern and debate the relevant virtues with their colleagues.
2) Even when virtues are discerned (e.g. courage, justice, prudence, etc.), knowing where to act on each virtue continuum (vice to vice via a mean) requires the development of the phronesis that can be regarded as the adjudicating or executive virtue.
3) Phronesis needs to be cultivated over time to offer a way to balance competing demands, relationships, multiple conflicts and a range of functional goals to find an ethical decision point that will bring good outcomes for their discipline, the professionals who are part of their profession and the people they serve with their services.
4) The methodology developed is a hybrid original that combines narrative based interview approaches with an arts and humanities analysis to produce an educational debating resource in the form of a video-based odyssey, plus other educational resources. This methodology could be used for any discipline inside or outside healthcare sector.
5) The odyssey is made up of six episodes that follow a consultant and GP as they navigate their way from medical school to experienced practice. All the scripts used are based on findings from the research, so the resource brings the collected narratives alive and provides an accessible way of understanding the findings, thus building on evidence This builds on evidence from the PI's previous research and publications that phronesis as one of the virtues from the virtue ethics family is best understood through story telling. The video series provides a debating resource for educational purposes, or in a Continuous Professional Development (CPD) environment. The debating resource helps practitioners practice establishing the mean in ethical decision making across all the relevant virtues for the situations they encounter in their medical practices.
6) The central finding is a mapping of 15 virtue continuums for the medical community which represent the 'collective wisdom' from the participants. The virtue continuums are based on the stories told by the participants. This mapping shows that for each virtue, as narrated by research participants, there is a continuum from vice to vice via a mean. What we have subsequently proposed is that there is a mean point in each case, arrived at via moral debate with fellow practitioners and collectively working towards wise action.
7) The theoretical development of the phronesis concept is fourfold from this research. First are the 15 virtue continuums that we argue represent the current 'collective wisdom' of the medical community in the UK. These 15 are available in the form of a 'Wisdom Wheel' app along with questions related to each virtue on the project website. Second is a theory of a three stage process for deciding on the way forward rather than it being a single stage decision process where practitioners have to consider all the virtues at one time. This has evolved into a decision making resource or tool to aide in action and on action reflection. Third is that we have found MacIntyre's thesis associated with virtue ethics for practice based communities the most relevant both in the findings and in the medical ethics literature associated with phronesis, and therefore the most useful resource for practitioners and educators for now. Finally, we are also working on developing Kaldjian's (2014) concept of medical phronesis proposed as 5 staged elements into 4 with one of the elements being pervasive. These findings were presented at the 3rd and final workshop on 22nd March 2018 and at many of the engagement activities listed in the Engagement section above. If anyone who reads this is interested in finding out more then please follow the link below or contact the PI, Dr Mervyn Conroy on m.conroy@bham.ac.uk.
Exploitation Route The findings in the form of the moral debating resource (a film series of 6 episodes plus supporting materials) are being piloted now in medical schools and by doctors in their CPD to help them with ethical decision making for the benefit of their patients and the well being of the wider community.

The methodology could be used for any sector where ethical decision making needs to be understood better and cultivated better by the sector professionals involved. This could be put to use by other researchers and then developed into a similar moral debating resource to not only reduce the scandals in that sector but also to contribute to the well-being of all in society. This is the case because the common good or purpose of an approach that draws on virtue ethics and phronesis is well-being for all in society. For MacIntyre (1981) this can only be achieved by providing moral debating resources in professional education whether at UG or PG stages. This project has achieved its aim of providing just such a resource for the medical community. The opportunity not only exists now to do the same for other practices that interact with medical community but also for other sectors that are calling for better ethical decision making like the medical practice community was doing. We hope that our research and its outcomes meet that call and need.
Sectors Aerospace, Defence and Marine,Agriculture, Food and Drink,Chemicals,Communities and Social Services/Policy,Construction,Creative Economy,Digital/Communication/Information Technologies (including Software),Education,Electronics,Energy,Environment,Financial Services, and Management Consultancy,Healthcare,Leisure Activities, including Sports, Recreation and Tourism,Government, Democracy and Justice,Manufacturing, including Industrial Biotechology,Culture, Heritage, Museums and Collections,Pharmace

URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/research/projects/2015/phronesis-and-the-medical-community.aspx
 
Description The need for this work to make an impact is apparent in the many scandals that have been reported in the media: e.g. acute hospital care, mental health services for young people and elderly social and residential care that have fallen behind what society would expect from a developed country like the UK. Health and well-being is a key element of everyone's concept of a happy life. However, there is considerable concern that healthcare is losing its moral compass due to the many different moral and non-moral standpoints playing upon it, and vying for prevalence (equal care for all in society, taking into account diversity, market forces, a business rationale, targets, austerity, etc.) This range of incoherent and irreconcilable ethical positions has led many theorists in healthcare to advocate virtue ethics and phronesis (practical wisdom) as a coherent way forward to realign/ retrieve the moral compass of those that provide health and social care. One of the common complaints reported in the media has been a lack compassion for service users. "you can have all the kind of knowledge in the world and apply it poorly and not be a very good doctor. I guess part of that kind of relates to the wisdom of when to do something and then part of that relates to the kind of soft skills of like being able to communicate effectively with patients and your colleagues and actually kind of being genuinely compassionate for people and stuff. But then of course the other side is true as well; you can be a very compassionate person but a useless doctor if you don't know what you're doing. I think those kinds of - they go hand in hand" This quote from one of our participants is part of the data set collected by the Phronesis (practical wisdom) and the Medical Community project. This AHRC funded project has completed, having collected a rich array of stories from 131 doctors and medical students and run a series of community focus groups and events The focus of this research, which is being carried out in collaboration with the medical schools of Birmingham, Warwick and Nottingham, is to understand what it means to the medical community to make wise and ethical decisions for their patients and their communities by using the concept of virtue ethics and phronesis to understand their stories. Further to understand what it means to cultivate phronesis through education and training through to becoming an experienced medical practitioner. Compassion has many different and contested definitions; but in our research, compassion (as defined by doctors and community members) was most often described as aligned to empathy and understanding and was seen as a key part of the virtues of both interpersonal communication and cultural competence (diversity awareness). Both experienced doctors and members of the community referred to the negative impact of workload, time pressures and resource scarcity on compassion. The above quote would suggest that being compassionate is one thing, being a wise doctor is another and so our research will impact on the debates about and practice of compassion, as well as many other areas of healthcare practice and policy. The final analysis has created a set of 15 virtues with stories describing how these are enacted with examples at the extremes (deficiency and excess) of each. These virtues include those commonly associated with the teaching of medical ethics such as justice, fairness and lawfulness and others such as cultural competence, communication and emotional intelligence. Phronesis, or practical wisdom, is sometimes defined as the executive virtue enabling health care practitioners and others to consider what action to take when faced with complex ethical issues. However, to date, empirical work in this area has been very limited: this research has addressed that gap. The output of the research includes a video debating resource plus accompanying tutor resources to enable medical schools and CPD educators to engage in debate about practical wisdom and how it can be developed and navigated. The hybrid methodology developed as part of this project to study phronesis has generated strong interest from an academic in the US who would like to replicate the study with a medical community connected to their university. We are also intending to apply the methodology be to inter-professional working in the healthcare sector and have produced another research proposal as a standard grant submission. What has emerged from the research into phronesis (practical wisdom) and the medical community is the importance of inter-professional working to arrive at ethically wise decision making that benefits not just patients, but society as a whole. Multi-Disciplinary Team (MDT) meetings, talking to nurses, allied health professionals and social workers, engaging with the police and many other disciplines that have a role in the health of patients and the community feature in the narratives we have captured. This finding matches what MacIntyre (1981) argued is required to bring well-being to all in society. However, just as MacIntyre identifies, we have found a lack of moral debating resources available for the inter-professional synthesis of the different virtues at play. Pilots that have used the resources in medical education have been conducted in the three participating medical schools, and we are now working with medical schools across the UK as part of a follow-on impact and engagement project that started in June 2018. The engagement work has stimulated much interest from delegates at all the events attended so far - all these are listed in the Engagement section. A workshop is planned for 29 March 2019 where we will bring together those people who are running pilots and evaluations and others with an interest in doing so. Academics, practitioners, policymakers and patient representatives are also invited. A tangible impact on future policy that has emerged is that the main whistle blower at Mid Staffs, an A&E Consultant, heard about our project, joined our Steering Group and has initiated a marketing group to help us engage with policy makers and others to make a difference to the way ethical decisions are being made today by the medical community. Out of that has come an engagement with the General Medial Council (GMC) regarding their approach to guidance on medical ethics and consent. Their 2018 consultation paper on the topic contains specific references to the development of professional values and outcomes. The values in the GMC consultation document parallel some but not all of the virtues found by the Phronesis and the Medical Community research but do not make reference to the phronesis virtue. We were invited to present the research findings at the GMC HQ in Manchester with key players from their HQ in London Skyping into the meeting on 25 January 2019. This meeting was designed to inform the analysis and implementation phase and they have asked that we return and maintain the connection to their work on developing this latest guidance. The RCGP have also shown a keen interest in the research the CEO has requested that we present the findings to them a mutually convenient time. These project findings are timely and relevant to public debates on the ethics and funding of health and social care practice given the constant feature of healthcare scandals in the media. A recent cross party convention suggested that patients are being 'failed' by the health and social care system in the UK. Many of the participants (medical students, junior doctors and experienced doctors) reported that the interviews provided a space to reflect on their ethical decision making practice, which they do not normally have the chance to do. Many said that it was good to understand for themselves the different considerations (virtues) that they took into account before making a decision. This will help them in improving their ethical decision-making moving forward as will their exposure to the moral debating resources that are the main output from the research. MacIntyre (2009) argues that the gradual erosion of arts and humanities curricula content in the form of moral debating resources in professional education has had a significant and negative impact on the formation of moral character and ethical practice. Economic and efficiency measurements and quantification can mask, reduce or sublimate matters of discretion and judgement (MacIntyre 1981) which are the key constitutional elements of phronesis. Many researchers within medicine have made the case for a reorientation towards phronesis in medical education and therefore 'Phronesis and The Medical Community' has provided a clear outcome that conveys what practical wisdom means to medics throughout their careers. The research captured through narratives from consultants and GPs at all stages in their careers the ways in which practical wisdom is created, maintained and moulded. The findings in the form of a film series and other educational resources follows the careers of two medics, a medical consultant and a GP, as they navigate their way through medical school and training and become experienced medical professionals. This highly innovative and accessible moral debating resource offers medical educators and their students at any stage in their medical careers a way to access the findings in an enjoyable way (rather than reading a long and detailed report) as they watch a medical consultant and general practitioner (GP) navigating their way in stages through the complexities of making ethical decisions. The six episodes plus other resources (newspaper articles, social media, etc.) to go with the film series are not prescriptive in terms of how best to go about decision making but instead provide an interactive arts based moral debating resource where they interpret meaning and debate how they think their ethical decision making could be nurtured and improved. The resource conveys the 'collective wisdom' accounted for by the medical community researched. Via the follow on impact and engagement project the findings in this film series format have been presented back to groups of students and doctors across the UK to help them debate the best ways of making ethical decisions in different situations. If this is successful in the UK then as well as expanding the application to inter-professional working and other disciplines in the health and social care sector, we expect the approach to take on a global perspective. In fact, there has already been keen interest from the US as well as with university contacts in low and middle income countries. The PI has been asked but had to turn down offers (due to his commitment on PMC) to take on the PI role for other similar research projects with this global challenge in mind using the methodology developed on this project.
First Year Of Impact 2018
Sector Communities and Social Services/Policy,Education,Healthcare
Impact Types Societal,Policy & public services

 
Description A range of PPI events: patient and community focus groups
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact In order to gain their perspective on wise decision making five focus groups were run in various neighbourhoods in Birmingham. Trust was an important virtue that the project explored by exploring how doctors both in -training and experienced perceive the development of this virtue in their practice. Through the conduct of patient focus group we were able to explore this virtue from patients' perspective. This helped understand more about what builds trust between patients and doctors from a patient and community perspective. We were interested to know how trust is first established and what builds and retains trust. The project worked with the community group associated with these groups to convene the focus groups at times and venues convenient for attendees. A poster and banner were produced to help advertise the focus groups (Appendix A.6a and A.8). Five focus groups were run with a 43 participants in total (Table 3). These were a mix of community and patient groups: Community groups: the project chose to run two focus groups in an area of Birmingham with a high percentage of residents from Black, Asian and Ethnic Minority communities with one having a specific focus on Asian women. Patient-specific groups: were a mix of those with an interest in health matters such as Healthwatch volunteers and GP Practice Patient Participation Group Chairs, or those with a specific health condition (Liver patients). The findings from these focus groups were fed back into the main project report and have been used in the RCGP and GMC presentations to influence policy development.
URL https://gtr.ukri.org/projects?ref=AH%2FM006646%2F1
 
Description Engagement with RCGP at the 2018 Annual Conference
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact Dr Richard Knox, one of the project Co-Is presented the findings and resources to the conference and he received many requests for more information on how to use the resources for training GPs at UG and PG level. All these contacts were logged and they have been contacted to see if they want to run pilots and be involved in the evaluation stage.
URL https://www.fsrh.org/events/past-events/rcgp-annual-primary-care-conference-and-exhibition/
 
Description Faculty of Medical Leadership and Management: What Next for Medical Leaders?
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Dr Mervyn Conroy presented his research findings to the conference including the film produced as a moral debating for UG and PG programmes. The audience of trainers and practitioners were very keen to participate in a pilot and evaluation of the resources and so were added to the log of people to be contacted.
URL https://www.fmlm.ac.uk/sites/default/files/content/resources/attachments/What%20next%20for%20medical...
 
Description First and second workshop influence
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact The first two project workshops stimulated much interest from the researchers, practitioners and policy makers that attended and provided feedback on how to engage policymakers. A third workshop is planned for 22 March 2018 with a much larger group of academics, practitioners, policymakers and patient representatives invited. The policy influence will come through the findings in the form of an ethical debating resource for medical schools and CPD providers.The methodology adopted is a hybrid that combines narrative based interview approaches with an arts and humanities analysis to produce an educational debating resource in the form of a video based odyssey. The odyssey is made up of six episodes that follow a consultant and GP as they navigate their way from medical school to experienced practitioners. Our analysis of the data identified a set of 'virtue continuums' which doctors tell us have a bearing on their decision making and which seem to change as they develop experience and practical wisdom. The odyssey collates the findings by using the narratives collected in an anonymised form to construct the storylines and scripts to convey the complexity of ethical decision making and where phronesis can be observed or not. The resource is not meant to be prescriptive, conveying 'this is how it should be done' but to convey the collective wisdom from our participants and allow students to debate the morality of each situation. The students can debate each episode and say whether they would do it differently with the decisions taken putting them in the place of the hero and heroine. This produces a virtual community 'safe placement' resource that can be used at any stage in medical practice. One of the participants, a senior consultant, said that there is a lack of opportunities for medical students and junior doctors do be able to learn practical wisdom because things have changed in terms of giving them a chance to practice and learn like an apprenticeship. The virtual community video series and other resources would fill that gap and give them a chance to make decisions but in a safe way in the virtual community. Students could even replay the scene with in a participatory style drama to obtain an even more engaged experiential development opportunity. A tangible influence on future policy that has emerged is that the main whistle blower at Mid Staffs, an A&E Consultant, heard about our project and has joined our Steering Group and initiated the marketing group to help us engage with policy makers and others to make a difference to the way ethical decisions are being made right now by the medical community.
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description General Medical Council
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact The GMC were very keen to use our findings to help them develop their latest ethical guidance policy for doctors. They are reviewing consent guidance. The consultation closed end of January 2019 and the team is due to start the analysis phase of the project. The GMC are starting to think about the implementation phase of the consent project and will be developing implementation plans over the next few months. They will consider the PMC research while they scope the implementation phase.
URL https://www.gmc-uk.org/about/get-involved/consultations/review-of-our-consent-guidance
 
Description Influence on Medical Policy and Practice
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Many of the research participants (medical students, junior doctors and experienced doctors) have reported that the interviews provided a space to reflect on their ethical decision making practice which they do not normally have chance to do. They particularly said that it was good to understand for themselves the different considerations (virtues) that they took into account before making a decision. This will hopefully help them in improving their ethical decision making moving forward. The main influences will come in the following areas: - Influence on decision making in medical practice . - Influence on existing guidelines and policy relating to medical ethics education provision. - Training/educational developments for postgraduate CPD programmes (including courses and course material). The findings will eventually be presented to wider groups of students, doctors, researchers and policy makers to help them debate the best ways of making ethical decisions in the context of medical practice. We are also in the process of engaging with a number of policy makers such as the General Medical Council (GMC) and we are planning a much wider engagement with medical schools across the UK in a follow on impact and engagement project if funding is approved.
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Connected Communities
Amount £860,000 (GBP)
Funding ID RRBO18360 
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom
Start 05/2015 
End 05/2018
 
Description Phronesis and the Medical Community: Follow on Impact and Engagement
Amount £80,642 (GBP)
Funding ID AH/S000763/1 
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom
Start 06/2018 
End 06/2019
 
Title Novel hybrid research methodology to study phronesis 
Description The methodology developed for this project provides a social science and arts based hybrid to present the issues of phronesis to medical professionals (or leadership disciplines in any context for that matter) to support better ethical decision making process. The analysis outputs include virtue continuum mapping and a video series plus other media to form a story line linked to an existing virtual community (Stilwell). It is also planned to produce a decision making briefing and debriefing tool or resource. The aim is to allow personalised ethical debate in medical schools, junior doctor peer groups or with experienced doctor peer groups to build phronesis that is relevant to the medical leadership and ethical decision making in their particular contexts and specialties. To date little research has explored the ways in which phronesis is cultivated over a period of time within one professional community. Conroy et al (2012) did this for a health and social care community including the medical community but there is an absence of research with medical professionals to explore how they have accumulated and enacted phronesis within their daily practice. Questions have rarely been asked as to how professionals are equipped morally (or otherwise) to navigate a chaotic world of practice rife with competing demands and relationships. To date, many researchers within medicine (e.g. Kaldjian 2014, Montgomery 2006) have made the case for a reorientation towards phronesis in medical education, but little has been undertaken to explore what that might look like. Existing studies have tended to capture practical wisdom within one snapshot, within one organisation or by following one practitioner. We have followed three communities of doctors over three time periods: beginning of formal medical study; on placement at the end of formal study; and established medical professionals with 5 years plus qualified experience. This design (Conroy et al 2015) will offer an opportunity to see how phronesis develops over time whilst enabling a varied discussion about how moral resources are accessed and what the role of formal education is in equipping practitioners for the messy and subjective realities of practice. By exploring how doctors at different points in their careers have access to or draw upon moral resources, the study gathered narratives about how they make 'good' decisions for the patient at hand; balancing care, compassion, quality, resources, capacity, medical outcomes and the wider well-being of the community. The added artistic element is that we gathered a collection of the participants narratives to creatively shape an original 'soap opera' style video series that connects to an existing virtual community of health and social care practitioners, patients and the public. That fictional virtual community is known as Stilwell (city suburb) with all the health and social care issues associated with a typical town in the UK. The methodology used is applicable to other sectors and disciplines such as care, education, law and business and therefore the research promises much wider benefits. This entry has three main sections. First it begins with an explanation of the methodology, second, the research design and methods are described in detail and then the entry ends with conclusions that explain the potential contribution to the field and the potential implications for policy and practice as well as suggested further research. Methodology The methodology needs to be capable of answering the following research questions: 1. What does phronesis (pratical wisdom) mean to medical students and practitioners? 2. To what extent is phronesis cultivated, maintained and moulded over the educational and practice life of doctors in the UK? 3. To what extent can phronesis be promoted through educational and practice interventions? Secondary questions: a. What does an empirical study of phronesis within the medical context tell us about theoretical debates in virtue ethics? b. Do understandings and enactments of phronesis change through medical education, and if yes how? c. How much room do doctors in the UK have for exhibiting phronesis in their professional practice? d. Does phronesis play a role in sustaining the community's trust in the medical profession? e. Are there enabling factors (e.g. presence of role models) and/or competing forces (e.g. marketization or bureaucratization) that influence the extent to which doctors can exhibit phronesis in professional practice? Conroy et al (2012) used MacIntyre's (1981) practice based community theory of virtue ethics including the virtue of Phronesis to present a mapping of virtue continuums for a health and social care community. The virtue continuums mapped were based on the stories told by the participants and showed where on the continuums each story was positioned hence the claimed Phronesis. What was clear from the last workshop with the community was how useful it was to the community to be able to see the virtue continuums presented and where the stories indicated decision points on the continuums. Their response to seeing this depiction of Phronesis was typically 'I realise now I need to move in x direction with y virtue continuum to make a better decision' (p9) In other words they were using the constructed picture of virtue continuums to help them improve their decision making based on their understanding of their own practice. This is very different to giving health and social care practitioners a set of ethical guidelines i.e. deontological principles to work to. Many writers on this subject e.g. Dawson (2010) have argued against the approach of using such ethical principles as they do not take into account the many different contextual variables of each ethical dilemma. What is missing from studies to date is a fully contextualised depiction of stories about decision making and how they relate to all the professionals involved. Dawson (2010) additionally argues against deontological guidelines arising from quantitative or qualitative based research that do not acknowledge the uncertainty in the research evidence. Conroy (2010) acknowledges this issue in qualitative studies using narrative accounts and argues for a social constructionist based narrative approach as an ethical way to approach leadership and virtue ethics research and change with practitioners. In other words stories told by practitioners to a researcher may or may not be accounts of what actually happened, however, they do offer a window into the socially constructed nature of ethics and intersubjective reality of decision making in the professional community they practice. The arts based development to the methodology described here offers an ethical approach to the research by constructing a video series that depicts a virtual medical community making decisions, again based on the stories as in Conroy et al (2012) but also themes and a serial with episodes as demonstrated in Conroy (2010) and Czarniawska (1997) that shows the characters developing in their Phronesis due to certain events and therefore for them, how and why particular decisions have been taken. This arts based addition to the presentation of findings is novel in that although the virtual community (Stilwell 2016) has been used before to help substitute for placements (Walshe 2009) and as a leadership development resource (Conroy and Corrie 2014) it has not been used for the specific purpose of showing the socially constructed virtues and Phronesis informed decision making. We argue that this methodological approach leads to a useful resource for doctors in pre-clinical undergraduate education and post clinical/graduate training as well as offering a CPD resource for experienced doctors. This innovation in the methodology means that research can bridge the gap (Smith 2016) between research and practice in an ethical way that could have a very positive impact on the medical community and impact positively on the public perception of that community. As we have seen above, an overall narrative approach to the nature of virtue (including phronesis) has been crucial to this project. In order to answer questions 1 and 2, we collected narratives of phronesis in action from medical students and doctors as well as narratives of the development of phronesis. We collected these narratives by conducting interviews, by observing medical students and doctors at work and by asking some of them to keep a narrative diary. We approached question 3 by involving the medical community in the co-production of a video series that uses dramatized stories to illustrate phronesis and its development in the medical context. In keeping with the narrative approach it is our contention that phronesis can also be best communicated and developed through narratives. For this part of the project we used a similar approach to that used by the Stillwell Multi-Media Virtual Community (Stilwell 2016) developed by the University of Cumbria. Methodological approach in detail The methods were designed to collect narratives, diaries and observations about phronesis from medical students and doctors at various stages of their careers in the United Kingdom. Three main forms of data collection were used in the first phase of the study: e-portfolio notes, interviews and ethnographic observations. Interviews were semi-structured and developed from story gathering methods developed in Conroy et al (2012). Observations used an overt non-participant approach and all field notes were taken as unobtrusively as possible. Some of the study participants were asked to bring or later send their e-portfolio reflections of important. All interview, observation and e-portfolio notes were entered into NVivo10 with confidentiality protected. Interviews Semi-structured interviews lasting roughly 45 -60minutes have been held with 131 participants from all four cohorts and are used as the primary form of data collection in the study. The interviews were lightly-structured at first starting by explaining that we are interested in exploring the participant's experience of making ethical decisions whether these be their own or others they work with. Also whether they perceived them to be good or not good decisions. Participants were allowed to start discussion of the topic wherever and however they want. If they did not respond to this then the interviewer might say 'It seems hard for you to start on this subject, would you like to start with the difficulty?' We then asked them about instances or stories that they allude to in the difficulty. If the interviewee presented facts or offers general accounts they were invited to give specific examples relating to their account. Experience from previous studies (e.g. Conroy 2010) show that for most interviews explanation of the research aims and active listening signals are an excellent means of generating stories. The secondary research questions (framed in relation to their accounts) informed the structure for the second part of the interview to gain clarification of context, the characters involved, dilemmas, competing pressures, community response, etc. Participants were asked to recount stories of the following sorts: • where they felt they have applied their own practical wisdom to a work situation • where they felt they could have acted more wisely • where they had seen a colleague making a particularly wise decision • where they had seen a colleague making a particularly unwise decision • whether they know of any particularly wise or unwise decisions that they have not experienced directly, but that have influenced them in their thinking • what they think the characteristics are of wise or unwise decisions in medicine. Observations Observations of individual participants from the four cohorts were undertaken during the fieldwork. Observing participants also provided context to the participants' development of phronesis (if it occurs), as well as their interviews and e-portfolios, which was important when developing the video series. A selection of experienced practitioners were observed in the multidisciplinary team meetings that many attend on a weekly basis. Participant kept diaries - e-portfolios Originally we were going to ask our participants to keep diaries about any ethical decisions they experience but we later established that some keep e-portfolios where they record their experiences and reflections. These are self-reflexive and can be used to provide context and reflections for decisions the diarist makes, or decisions they see others making in practice. The participants were asked to send e-portfolios to the researchers. Only a few e-portfolios were collected and entered into NVivo. Analysis The initial social science-based analysis was used as a way to reveal themes and extract stories and a serial for the arts-based analysis. The thematic (social science) analysis element used a Framework Approach (Ritchie et al 2010) to yield themes or categories of what doctors find important, typologies of people and events and medical workers' behaviour. Virtue Continuum coding was conducted in NVivo 11. The end goal was to consolidate a set of virtues contained in the data that could be used as the basis of the video series and the theoretical analysis. The nature of phronesis was examined through two theoretical lenses: MacIntyre's (1981) virtue ethics and Kaldjian's (2010) medical phronesis. Virtue ethics provides a virtues-goods-practices-institution schema (Moore and Beadle 2006) which comprises a number of theoretical concepts relating to phronesis: • Virtues: disposition to act in a certain way that enables us to achieve internal goods (includes wisdom) • Internal goods: the excellence of products/services and the perfection of the individual in the process. • External goods: only contingently attached to a practice e.g. money, status and power Practice: any coherent and complex form of social activity e.g. medicine, nursing, social work etc. • Institutions: primarily concerned with producing and distributing external goods • Narrative quest: search for our purpose (telos) toward wellbeing (eudaimonia) • Communal narrative quest: arising from a meshing of practice virtues and a telos of collective wellbeing. The Medical Phronesis lens held alongside virtue ethics helped us to contextualise the notion of phronesis. According to Kaldjian (2010: 559), phronesis in the context of medicine encompasses: • Pursuit of worthwhile ends • Accurate perception of concrete circumstances • Commitment to moral principles and virtues • Deliberation that integrates ends, concrete circumstances and moral principles or virtues • Motivation to act in order to achieve the conclusions reached by such deliberation. An initial output of the analyses has been a virtue continuum mapping of 15 virtues to illustrate phronesis enactment across all the data. The next stage was the virtual community media production. The media includes a video series, blogs, social media, newspaper pages etc. to create a whole teaching package. The process of moving from data and analysis to the video series was a co-production between the creative director, the research team, participant representatives and a consultant and GP. Initially a series of workshops were convened to map out the story boards and characters for the video serial and to link to characters within the wider Stilwell virtual community (http://www.stilwelleducation.com) Once the story boards were agreed the creative director arranged for a script to be written for each video episode based on our findings (15 virtue continuums and the narratives from our participants relating to each virtue) The scripts was reviewed by cohort representatives, the researchers and medical educators from each of the partnering institutions. Ethical dilemmas are presented in each episode and provide focus for each episode. These will be related to a session within a series of blocks in a medical training programme module. For example a first theme might be 'From Pillar to Post' showing the competing pressures as described above and the potential for impressionable and unstable positions taken by a fledgling doctor. Second might be 'A Purposeful Stand' showing a doctor gaining clarity of purpose and deciding where they stand in relation to the competing pressures, ideologies and practical dilemmas. Third might be 'Maintaining an Ethical Stance' showing how that stance plays out in a number of different interactions with other doctors, nursing staff, patients, family, social services etc. and how in practice that stance might not always produce the desired outcomes for patients. These examples show that many different themes and storylines that were explored in a serial format with the same characters to enable medical student reflection and debate on the concept and practice of phronesis. Once the scripts were agreed the film production team, who are well versed in Stilwell productions, co-produced the videos using professional actors and advice from cohort representatives, a consultant and the researchers. Conclusion The methodology described here is capable of providing an artistic presentation of the issues of phronesis in a medical community or any practice based community for that matter. The video series 'soap opera' and the way it links to the existing virtual community will be debated with a broad audience of academics, practitioners, patients and policy makers and others with an interest in the field at our final workshop. The video series will offer an innovative, edgy complement to the many text based recommendations that have emanated from scandal enquiry reports and social science based studies to date. New understandings of the cultivation of phronesis in medical communities and its role in rebuilding public trust in the light of many scandals will be of interest to healthcare researchers, educators, practitioners and policymakers. The aim is to impact on the medical and professional education of doctors as a community, building stronger links between the medical community and the public and rebuilding public confidence in the medical profession. MacIntyre (1981, 2009) argues that moral debating resources are missing from ethical education and the wider theological and philosophical context of any practice. We argue here that the methodological approach and the resultant outputs offer the education and training of doctors a moral debating resource in the form of virtue continuum mapping and the added resource of a video series plus other media to form a virtual community presentation and the possibility of a decision making resource to aide in-action decision making and after- action reviews of decision making. 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact A great deal of interest has been shown in the methodology and the PI, Dr Mervyn Conroy, has been approached by academics from the UK and the US who have asked him to share the methodology so they can replicate the study with medics and nurse in healthcare institutions connected to their universities. A journal publication is in progress and will be published later this year. 
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Title Wisdom wheel app and three stage phronesis process 
Description The tool here has been developed through the insights gained from the research into what it means to physicians to make wide ethical decisions for patients and their communities. The wisdom wheel contains 15 virtues and related questions as the collective wisdom from the participants. It is available on a website for those participating in the pilots and evaluations. The idea is that they can use this resource with the film resources and accompanying materials to support UGs, PGs and CPD programmes. IT offers a very powerful moral debating resource for practitioners at all levels to help them improve their wise decision making. 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact Already the tools are being used by medical ethics tutors and trainers on UG, PG and CPD programmes to support improvements to the education and practice of ethical decision making for the medical community. 
URL https://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/phronesis/phronesis-in-...
 
Title Hybrid data analysis methods: social science and arts based . 
Description Phronesis (practical wisdom) is in demand for the medical community in order for them to arrive at wise decisions. Arguments to date are that it is important for good practice, the 'natural' ethical approach, valued for the contribution it makes to the 'professional artistry' of medicine and that it promotes 'reflective ability and moral reasoning' However, there is a gap in understanding what phronesis means and what doctors, medical educators, professional bodies and researchers could contribute to cultivating phronesis. The dearth of moral debating resources and the particularistic limitations associated with the many guidelines in all stages of medical ethics training is an established issue. The lack of connection between research into phronesis and the application to the medical discipline is significant. The methodology described here is different to what medical ethics has used previously - it integrates ethics, social science and arts. It offers a social science and arts based hybridisation to understand the issues of phronesis in the medical profession and to support the cultivation of virtue ethics based ethical decision making. Outputs from the analysis include virtue continuum mapping and a video series plus other media to form a modern medical odyssey linked to an existing virtual community. We argue here that this new methodological approach and the resultant outputs will fill the gap in understanding phronesis and overcome the limitations of existing resources available to nurture a phronetic approach in medicine. 
Type Of Material Data analysis technique 
Year Produced 2018 
Provided To Others? No  
Impact The methodology developed as part of this project has allowed the research team to capture what phronesis means to three large medical communities in the UK and can be used to capture what it means to any other practice based discipline. The methodology will be published in a journal paper later this year. 
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Title Virtual Community Placement: Medical Community Moral Debating Resource 
Description In addition to the Virtue Continuum model reported on in my previous award we have used a virtual community arts based approach to the analysis of the data and to animate the findings. This involves creating a storyboard from the data and then converting that to a video series and other social media to convey the findings as an arts based participatory virtual community of doctors to go with the existing (Stilwell) health and social care virtual community. In this way doctors early on in their training or in CPD can interact in a safe way as though they were in a real placement environment. They can use the resource to reflect on a current practice dilemma or to develop their understanding and approach to making ethical decisions in future. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? Yes  
Impact An early pilot with the video episodes has been presented to medical postgraduate students and they enjoyed watching the materials and it allowed them to debate the ethical issues at stake and what it means for their practice. A further list of 72 people from medical schools and CPD providers who requested to use the resources at the various engagement activities has been compiled. Some have already agreed to pilot the resources and take part in the evaluation. 
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/news...
 
Title Virtue Continuum Model 
Description MacIntyre"s colossal body of writing on ethics that positions his mid career thesis 'After Virtue' (1981) contains very strong arguments of what we have lost in our understanding of community and societal connections. That loss is of shared virtues which operate through practice in service of wellbeing for all in society. In MacIntyre"s virtues-goods-practices-institution schema (Moore and Beadle 2006) practice excellence offers rewards for practitioners and citizens (internal goods), binds practitioners in one practice group together, binds different practice groups together across institutional boundaries and further still binds people across sectors in any given community. The theory encompasses dynamic development of community connections by members who are continually clarifying their personal aims by meshing with collective aims in a way that serves the wellbeing of all in society. Virtue ethics in this form can be viewed as building on social learning theories to encompass the ethical connections between all practitioners in any given society regardless of discipline. The way MacIntyre envisages the collective relationship of practices, the narrative of the institution and their potential disruption is summarised by McCann and Brownsberger (1990) who stress the centrality of telos (purpose) to human life. Disruption may involve loss of a shared sense of telos and a corresponding lack of agreement concerning social practices and the virtues that underpin them. For MacIntyre (1985) disruption and corruption derive more often than not from an (individual or collective) bias in focus on external goods (money, status and power) rather than on internal goods. Workshop illustration: virtue as a mean In order to apply the theoretical lens afforded by MacIntyre it becomes important to understand the notion of virtue as a mean growing out of engagement with that practice, not predefined. Any community needs rules or an ethos to hold it together: Aristotle in Nichomachean Ethics (1958) suggests a set of virtue continuums (Courage, Generosity, Magnificence, Pride, Anger, Truth and Indignation). MacIntyre was careful to avoid such definitions, and we therefore allowed the accounts from our workshop practitioners to define the virtues of connectedness. Using a virtue continuum lens we mapped stories of connected communities from our workshop participants (Figure 1 - see the URL) Within the workshop from the first study (and in the data from the PMC study) we have examples of practice which counters policy and practice impositions. The focus was the incremental development of working relationships within and across communities, engaging with the learning in communities and seeking to develop a common purpose. The virtue continuum model has been developed in the subsequent 'Phronesis and the Medical Community' award to consolidate 15 virtues from the narratives of 131 medical community participants. 
Type Of Material Data analysis technique 
Year Produced 2015 
Provided To Others? Yes  
Impact The seminar suggested that the model was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in Health and Social Care Communities. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrupted. 'Phronesis and the Medical Community' has used and built on this virtue continuum model and has captured 15 VCs that were conveyed in the stories from the 140 participants. 
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...
 
Title What phronesis (practical wisdom) to inform their ethical decision making means to the medical community 
Description Virtually all citizens of the UK receive care from doctors in the NHS and have an interest in being treated with dignity and receiving good care, which is inextricably linked with phronesis (practical wisdom) and professional values (Good Medical Practice GMC 2013). The study has collected data from 131 doctors through their professional careers on what it means to them to cultivate phronesis (practical wisdom) in the midst of navigating the complex world of healthcare in an era of markets and user choice. The data conveys how they make context-dependent, localised and 'good' decisions for patients and the wider community. It also contains stories they told of what they considered to be unwise decisions. It is added to by data from the public and patients on the role that phronesis plays in strengthening and sustaining trust between the medical community and wider health and social care community. Given recent health and care scandals, this data, since it contains a wealth of practical wisdom, is expected to increase the flow of ethical decision making through a greater emphasis on (initial and continuing) education in phronesis based ethical decision making in the UK and internationally. A video series has been produced which animates the findings and which can be viewed by other researchers and used in educational settings. It can be used to contribute to move the debate along in research contexts, and provide impact on medical education as rapidly as possible. The video series demonstrates a range of practice situations and patients based on the narratives from the research and shows maturing medical practitioners gaining a sense of what it means to make good decisions despite the complexity of their roles and pressures they experience. The methodology used to capture this data (described in the methodology section) will be applicable to other sectors such as care, education, law and business and therefore the research promises much wider social and economic benefit. 
Type Of Material Database/Collection of data 
Year Produced 2018 
Provided To Others? Yes  
Impact Our methodology and methods including the the virtue continuum model and arts based virtual community analysis have already been requested for replication in the US with the medical community by a senior academic in the field at Virginia University. 
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/news...
 
Description Collaboration between Health Services Management Centre (HSMC) and the Education department at University of Birmingham 
Organisation University of Birmingham
Department School of Chemical Engineering
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Hendrik Kotzee from the Education department was a Co-I on the project.
Collaborator Contribution Kotzee (Co-I) was Director of Medical strand of 'Values and Virtues in the Professions' Project in the Jubilee Centre for Character and Virtues and brings expertise in applied ethics as well as experience in the empirical study of ethics in the medical profession. He also has expertise in operationalizing ethical concepts and studying them empirically. He was involved in the literature review, methodology and methods to support links to the latest theoretical currents. He has contributed as co-author to project papers.
Impact Journal Publications
Start Year 2015
 
Description Collaboration between Health Services Management Centre and the Medical and Dental School at University of Birmingham 
Organisation University of Birmingham
Department Institute of Inflammation and Ageing
Country United Kingdom 
Sector Academic/University 
PI Contribution Mervyn Conroy (PI) is a Senior Fellow at HSMC and has led all aspects of the collaboration to ensure that the project's aims and objectives are met and delivered on time and within budget. His arts and health practitioner/academic crossover experience, three previous AHRC Connected Community projects, one as PI and two as CoI along with expertise in virtue ethics, phronesis and health services organisation/leadership has enabled him to support this collaboration. Chairing of regular Ops meetings and Steering Group meetings with collaborators in attendance.
Collaborator Contribution Catherine Hale (Co-I) is a Senior Lecturer in Medical Law and Ethics and brings expertise in the discipline and teaching of medical ethics and law to both medical students and doctors, within medical schools, post-graduate deaneries and hospital trusts. She has expertise in curriculum design and review, novel teaching methods, teaching management, as well as student engagement. She has been the link with the collaborating medical schools and hospital trusts and she has been pivotal in gaining commitment from the external partners.
Impact The collaboration across the whole of the project is multi-disciplinary. This particular collaboration has resulted in publications that are listed in the publications section. Cathy Hale has taken up a Co-I role on the Follow on Impact and Engagement Project.
Start Year 2015
 
Description Collaboration between Health Services Management School at University of Birmingham and the University of Nottingham Medical School 
Organisation University of Nottingham
Department School of Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Mervyn Conroy (PI) is a Senior Fellow at HSMC and has led all aspects of the collaboration to ensure that the project's aims and objectives are met and delivered on time and within budget. His arts and health practitioner/academic crossover experience, three previous AHRC Connected Community projects, one as PI and two as CoI along with expertise in virtue ethics, phronesis and health services organisation/leadership has enabled him to support this collaboration. Chairing of regular Ops meetings and Steering Group meetings with the collaborators in attendance.
Collaborator Contribution Dr Richard Knox, a GP and GP trainer at Nottingham Medical School was a Co-I on the first project and provided initial support to the Follow on Impact and Engagement project Ethical approval for the study was obtained through the University of Birmingham in collaboration with partners at the Universities of Warwick and Nottingham. In addition, HRA ethical approval via IRAS was sought by the Birmingham based Research Fellow for the collaborative NHS partners in order to facilitate the collection of observational data. The main data collection was through interviews with four groups of participants from each of the 3 institutions (Birmingham, Warwick and Nottingham) and a 5 years plus experienced group: ? 10x3 medical students at the beginning of formal medical study (year2) ? 10x3 medical students at the end of formal medical study (year 5) ? 10x3 doctors who are on placement in their foundation years at the end of formal study (F1 and F2) - a transitional cohort to offer a longitudinal flexibility to the study of practical wisdom whilst enabling a varied discussion about how moral resources are accessed and what the role of formal education is in equipping practitioners for the messy contingencies of practice. ? 10 established medical professionals with 5 years plus qualified experience. Interviews started with an open declaration of the interests of the study and initially involved gaining an understanding of what making wise ethical decisions means to the interviewee. Lead a review of medical ethics and professional virtues in teaching at the medical schools at the Universities of Birmingham, Nottingham and Warwick. Members of the Steering Group included the formal collaborative partner medical schools and hospital trusts of Birmingham, Nottingham and Warwick, Health Education England, and there was also a patient representative, medical student, consultant and GP on the Steering Group as well as academics and professionals from a range of related disciplines. All three representative members from Birmingham, Warwick and Nottingham Medical Schools have responsibility for ethics teaching within the medical undergraduate and postgraduate curriculums. This positioning will allow them to pilot the Stilwell learning resource. It will also allow them to generate a curriculum review of medical ethics and professional values teaching within their own medical schools and make recommendations for modifications or amendments to the existing teaching programmes on the basis of the study's findings. The Universities of Birmingham, Nottingham and Warwick will disseminate findings and the video product to other allied health care professional courses and other professional courses within their immediate academic network.
Impact All collaborators have been contributing to the project outcomes. The collaboration is multi-disciplinary: patient representatives, medical students, medical consultants, GPs, medical ethics academic and a GP training academic.
Start Year 2015
 
Description Collaboration between Health Services Management School at University of Birmingham and the University of Warwick Medical School 
Organisation University of Warwick
Department Warwick Medical School
Country United Kingdom 
Sector Academic/University 
PI Contribution Mervyn Conroy (PI) is a Senior Fellow at HSMC and has led all aspects of the collaboration to ensure that the project's aims and objectives are met and delivered on time and within budget. His arts and health practitioner/academic crossover experience, three previous AHRC Connected Community projects, one as PI and two as Co-I along with expertise in virtue ethics, phronesis and health services organisation/leadership has enabled him to support this collaboration. Chairing of regular Ops meetings and Steering Group meetings with collaborators in attendance.
Collaborator Contribution Ethical approval for the study was obtained through the University of Birmingham in collaboration with partners at the Universities of Warwick and Nottingham. In addition, HRA ethical approval via IRAS was sought by the Birmingham based Research Fellow for the collaborative NHS partners in order to facilitate the collection of observational data. The main data collection was through interviews with four groups of participants from each of the 3 institutions (Birmingham, Warwick and Nottingham) and a 5 years plus experienced group: ? 10x3 medical students at the beginning of formal medical study (year2) ? 10x3 medical students at the end of formal medical study (year 5) ? 10x3 doctors who are on placement in their foundation years at the end of formal study (F1 and F2) - a transitional cohort to offer a longitudinal flexibility to the study of practical wisdom whilst enabling a varied discussion about how moral resources are accessed and what the role of formal education is in equipping practitioners for the messy contingencies of practice. ? 10 established medical professionals with 5 years plus qualified experience. Interviews started with an open declaration of the interests of the study and initially involved gaining an understanding of what making wise ethical decisions means to the interviewee. Lead a review of medical ethics and professional virtues in teaching at the medical schools at the Universities of Birmingham, Nottingham and Warwick. Members of the Steering Group included the formal collaborative partner medical schools and hospital trusts of Birmingham, Nottingham and Warwick, Health Education England, and there was also a patient representative, medical student, consultant and GP on the Steering Group as well as academics and professionals from a range of related disciplines. All three representative members from Birmingham, Warwick and Nottingham Medical Schools have responsibility for ethics teaching within the medical undergraduate and postgraduate curriculums. This positioning will allow them to pilot the Stilwell learning resource. It will also allow them to generate a curriculum review of medical ethics and professional values teaching within their own medical schools and make recommendations for modifications or amendments to the existing teaching programmes on the basis of the study's findings. The Universities of Birmingham, Nottingham and Warwick will disseminate findings and the video product to other allied health care professional courses and other professional courses within their immediate academic network. As part of the follow on project the team is disseminating research findings and video learning package within the NHS, to allied health care professionals, patient representation groups and NHS workers through secondary care hospital networks, and the Department of Health.
Impact All collaborators have contributed to the outcomes. The collaboration is multi-disciplinary: patient representatives, medical students, medical consultants, GPs, medical ethics and law academic and psychology academic. Warwick have continued to partner on the Follow on Impact and Engagement Project.
Start Year 2015
 
Description Collaboration between the Health Services Management Centre and Medicine, Ethics, Society & History (MESH) at the University of Birmingham. 
Organisation University of Birmingham
Department Medicine, Ethics, Society & History (MESH)
Country United Kingdom 
Sector Multiple 
PI Contribution Mervyn Conroy (PI) is a Senior Fellow at HSMC and has led all aspects of the collaboration to ensure that the project's aims and objectives are met and delivered on time and within budget. His arts and health practitioner/academic crossover experience, three previous AHRC Connected Community projects, one as PI and two as CoI along with expertise in virtue ethics, phronesis and health services organisation/leadership means he is well placed to support this collaboration. Chairing of regular Ops meetings and Steering Group meetings with all the collaborators in attendance.
Collaborator Contribution Angus Dawson is Professor of Public Health Ethics and Head of Medicine, Ethics, Society & History (MESH). He has published extensively in medical ethics and has a long-standing interest in the production of ethical behaviour in health professionals. He worked on a collaborative research project exploring ethical behaviour of pharmacists for the Royal Pharmaceutical Society of Great Britain. He has been involved for many years in training members of research ethics committees and teaching ethics to medical students, public health professionals and trainees in the UK, US, Taiwan, Canada, India, Bangladesh and Sri Lanka. He is joint Editor-in-Chief of the journal Public Health Ethics and on the editorial boards of five other ethics journals. He has acted as consultant on the project and acted as the stand in PI when MC was on sick leave and provided advice on literature, theory, instrument design and analysis.
Impact All the collaborations have contributed to the outcomes listed.
Start Year 2015
 
Description Collaboration between the Health Services Management Centre and the Jubilee Centre for Character and Virtues at the University of Birmingham. 
Organisation University of Birmingham
Country United Kingdom 
Sector Academic/University 
PI Contribution Mervyn Conroy is the PI and has worked closely with Professor Kristján Kristjánsson, Deputy Director of JCCV, who was a Co-I on this project but had to leave due to increased pressures on his role in JCCV. MC asked KK to produce a theoretical presentation of phronesis at the first project workshop which developed into a publication for KK in Theoretical Medicine and Bioethics - see below.
Collaborator Contribution Kristján Kristjánsson (KK) is Professor of Character Education and Virtue Ethics and Deputy Director of Research at the Jubilee Centre for Character and Virtues at the University of Birmingham. He is the author of six books on virtue ethics, moral development and education and the author of numerous peer-reviewed journal articles. He is an acknowledged expert on neo-Aristotelian approaches to virtue ethics. He acted as a consultant on the project and provided advice on literature, theory, instrument design and analysis as well as contributing to the second theoretical paper listed below.
Impact Professor Kristjánsson was asked to present a paper at the launch workshop for the research project on phronesis theory which he did. The paper presented was subsequently published as a paper for the project and is listed in the publications for this Research Fish entry. It is the first journal article produced by the project. He also agreed to help Conroy with a second theoretical paper and be a co-author.
Start Year 2015
 
Description Health Services Management School at University of Birmingham and the University of Cumbria 
Organisation University of Cumbria
Country United Kingdom 
Sector Academic/University 
PI Contribution Mervyn Conroy (PI) is a Senior Fellow at HSMC has led all activities including collaborations to ensure that the project's aims and objectives are met and delivered on time and within budget. For this collaboration MC has chaired all the workshops and meetings with UoC and he and his team have provided extensive research findings input to the design of the Stilwell package.
Collaborator Contribution University of Cumbria own and host Stilwell (a virtual community of health and social care storylines using a range of media including video) and have welcomed the addition of the medical community to the storylines. The PI has a strong link with Cumbria having completed related AHRC research (Conroy et al 2012 and Froggett et al 2013) whilst on secondment from Birmingham.The University of Cumbria has written, filmed and produced a series of six episodes that are based on the findings from the Phronesis research project conducted by the PMC team. A film production team including professional actors has produced the video series and the other media resources to go with the film series. Experience and external influences in the form of narratives are derived from the findings of the research and represented in a series of films written, produced and directed by students and staff from the University of Cumbria School of the Arts and supervised by senior staff within the school. Professional actors have been cast for the main parts. The findings are hosted on the University's digital learning platform Stilwell. Virtues to be covered in the films and other media were agreed at a series of meetings from summer to winter 2017. The University of Cumbria delivered 6 episodes each of approximately 10 minutes duration that reflect the agreed virtues in relation to medical professionals at different stages of their career. The University of Cumbria worked in partnership the University of Birmingham to produce scripts and other media that reflect the results of the Phronesis research. The script and other media are written by the University of Cumbria with the guidance and agreement of the University of Birmingham. Filming and Editing Filming occurred at University of Cumbria premises starting in November 2017. The University of Cumbria have been responsible for sourcing locations, recruiting professional actors and technicians to film the Phronesis findings. The University of Cumbria have been responsible for editing the finished product after comments were received from the PMC team members. Other media As part of the Stilwell virtual community and to convey more fully the context to the films other media such as newspaper articles, social media, patient notes (fictitious), and staff/character profiles are provided as part of the package in keeping with other Stilwell productions used for educational purposes and provide a safe placement or ethical debating resource. Delivery and hosting The University of Cumbria will delivered the completed film in electronic form (flash drive) as well as hosting the series of films on the University's Virtual learning Environment "Stilwell" (www.stilwelleducation.com) The professionally directed, acted and produced series of a virtual medical community or medical 'soap opera': with audio-video clips of doctor-patient, doctor-staff, doctor-next of kin interactions; focus on and illustrate the development of phronesis through the practical resolution of ethical dilemmas. This is a resource for Medical Schools, Health Education England, NHS (both primary and secondary care) and other medical and allied healthcare educational establishments.
Impact A series of co-produced Stilwell video-clips created by UoC to animate the findings and show the progression from the contained environment of medical school to interactions with other professions, hospital boards, the community in the form of patients' family, patient representatives, pressure groups, press reports etc. Stilwell provides this all important contextualisation as it already contains a hospital, GP practices, all the associated health professions as well as social services, ambulance services, police force, fire services etc. plus a whole community of characters who interact with the services as patients, carers, family, friends etc. This project will add a medical school to the community and through the video series will provide insight into the cultivation of phronesis through the life of a maturing consultant and GP and also the community response to the enactment of phronesis all informed by the stories collected from the participants. This product could become a resource for Medical Schools, Health Education England, NHS (both primary and secondary care), CPD providers and other medical and allied healthcare educational establishments.
Start Year 2015
 
Title An approach to cultivate phronesis in the medical discipline and any other discipline. 
Description 1) Virtue Continuum Model for the medical community (plus process flow model - see 4) below) 2) Virtual Medical Community Video Series and other associated media 3) Teaching notes to go with the above 4) Process tool to aide decision making: briefing tool for use before, in and after action i.e. to aide medical practitioners in their reflection on complex ethical decisions. Here it is pertinent to mention that we can integrate the mean from the virtue continuums, goals and context to come to an ethical/wise decision for a/this particular patient. What we have observed in the data/cases used for Kaldjian analysis is that even if the goals and context are known/clear the utilization /presence of virtues is important as their absence usually leads to unwise decisions/ non-phronetic decisions. IPR and patenting of the outputs that potentially are applicable to recording in this section are currently being considered by our commercial and contracts department. 
IP Reference  
Protection Copyrighted (e.g. software)
Year Protection Granted 2018
Licensed Yes
Impact Already covered in earlier sections
 
Title Stilwell video series and the accompanying tutor notes and other resources 
Description This resource is the main output from the research for use in medical schools and CPD training programmes. 
IP Reference  
Protection Copyrighted (e.g. software)
Year Protection Granted 2018
Licensed Yes
Impact Licencing of the research output materials in the form of the Stilwell video series and the accompanying tutor resources.
 
Title Virtue Continuum Model for mapping the stories of communities working together to bring successes 
Description This discovery was originally made in a previous study that the PI completed in 2012 for the AHRC and it has now been developed in the PMC project. The discovery is described in previous sections. 
IP Reference tba 
Protection Patent application published
Year Protection Granted 2011
Licensed No
Impact The original study seminar suggested that the above theorising was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in H&SCCs. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre's thesis that the resources to maintain such ethical debates have become disrupted. The initial pilot for the PMC project again indicates this to be a useful model for practitioners to understand and apply to their discipline.
 
Title Wisdom wheel and 3 stage process 
Description The tool here has been developed through the insights gained from the research into what it means to physicians to make wide ethical decisions for patients and their communities. The wisdom wheel contains 15 virtues and related questions as the collective wisdom from the participants. It is available on a website for those participating in the pilots and evaluations. The idea is that they can use this resource with the film resources and accompanying materials to support UGs, PGs and CPD programmes. It offers a very powerful moral debating resource for practitioners at all levels to help them improve their wise decision making. 
IP Reference  
Protection Copyrighted (e.g. software)
Year Protection Granted 2018
Licensed Yes
Impact Notable is the interest that has been shown in the resources derived from the research right across the medical schools in the UK and related CPD providers.
 
Title Virtual Community Safe Placement Intervention for Doctors in Training 
Description What this product and intervention consist of is an ethical debating resource in the form of a virtual medical community representation of the findings to allow doctors in training or in CPD to put themselves in the position of making an ethical decision and deciding what is the appropriate action in a safe way. Further debate is also possible without putting any patients at risk. 
Type Support Tool - For Medical Intervention
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2018
Development Status Under active development/distribution
Impact The resources have been piloted at 3 sites: Birmingham, Nottingham and Warwick medical schools. Another 72 contacts have been collected through the engagement activities and the next stage is facilitating those people with pilots and evaluation of the resources. 
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/news...
 
Title Virtue Continuum Model 
Description The seminar suggested that the virtue continuum model was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in H&SCCs. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrupted. This model is now being used in the 'Phronesis and Medical Community' which is a follow on project (Conroy et al 2015) focusing on doctors and ethical decision making. This research aims to answer what it means to doctors to make good ethical decisions. 
Type Health and Social Care Services
Current Stage Of Development Refinement. Clinical
Year Development Stage Completed 2016
Development Status Under active development/distribution
Clinical Trial? Yes
UKCRN/ISCTN Identifier AHRC Grant (RRBO18360)
Impact The seminar suggested that the model was helpful to participants (policy makers, practitioners and researchers) in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in Health & Social Care Communities. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrupted.The Phronesis and the Medical Community project has used the model to analyse the data and will be presenting it as an intervention as part of the early findings at the next workshop on 22 March 2018. 
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...
 
Title Virtual Community Technical Product on DVD or You Tube 
Description This is covered in the previous creative entry as an artistic product and could be considered a technical product especially when combined with the virtue continuums Wisdom Wheel. It offers a new way of supporting doctors in their interest of making good ethical decisions for their patients and wider community. The virtue continuum will come with a process for application that consists of two or three stages in coming to a decision. So rather than having to consider all the virtues in one go they can be broken down into stages. The video series could be adapted to show this happening in practice but that would be either as part of a follow impact and engagement project or a separate project backed up by further research. 
Type Of Technology New/Improved Technique/Technology 
Year Produced 2018 
Impact The notable impacts would be that patients, their family and their communities feel more trusting of the medical community and that their clinical outcomes and experiences in the healthcare system are improved. However this has yet to be evaluated. We hope to start that process of evaluation as part of the follow on impact and engagement project if funding is approved. 
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/news...
 
Description 2018 International Studying Leadership Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Dr Mervyn Conroy presented a paper on the research findings from the main project as part of the follow on funding impact and engagement project. The paper title was 'Phronesis & ethical decision making for leaders'
Year(s) Of Engagement Activity 2018
URL http://wp.lancs.ac.uk/islc-2018/
 
Description AHRC Catalyst Event: Co-Creating Pathways for Change - University of Highlands and Islands, Scotland 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Dr Mervyn Conroy was invited to take part in a round table discussion and present the findings from the phronesis project: Enabling Change: Developing Phronesis & Drawing Upon Narrative in the Healthcare Sector. Phronesis or practical wisdom is a concept which advocates a way to make ethical decisions that are grounded in an accumulated wisdom gained through previous practice dilemmas and decisions.

The full programme was as follows:

Co-creating Pathways for Change
Symposium 2018
Creative Engagement in the Health and Care Sector:
Who is our 'community'?
9.30am - 14.30 - Thurs 21st June, An Lochran Lecture Theatre
Registration from 930am - Coffee & Pastries on arrival - Lunch provided at 1330
Venue: An Lochran, Inverness Campus - NOT Inverness College Building - the next one!
Getting There: www.invernesscampus.co.uk/get-there/
10.00am Welcome & Introduction Dr Sarah-Anne Munoz, UHI Rural Health & Wellbeing
10.10 Rural Lives: Do Creative Forms of Engagement Matter? Dr Issie MacPhail, UHI Rural Health & Wellbeing
10.25 Incoming Voices: Readings from the work of Raman Mundair, Artist & Poet, Shetland, & the late Jo Skelt, Representing Hodgehill & other rural stories
10.40 Rural Voices: Insights from Catalyst Roundtable NHS, Local Authority & Third Sector
10.55 Urban Voices: Creating spaces for engaging the voices of minorities - Learnings from Representing Hodge Hill: Dr Qulsom Fazil, University of Birmingham
11.25 Coffee & 'Making' Break: Group Work
12.15 Enabling Change: Developing Phronesis & Drawing Upon Narrative in the Healthcare Sector Dr Mervyn Conway, University of Birmingham
'Phronesis or practical wisdom is a concept which advocates a way to make ethical decisions that are grounded in an accumulated wisdom gained through previous practice dilemmas and decisions.'
12.45 Making Break Feedback and Discussion: Pathways for Change
? Who needs & wants creative engagement in policy development & delivery?
? What are the barriers & opportunities?
? Who needs to be involved - who is 'our community'?
? What needs to happen next?

The roundtable debate and research findings presentation engaged the audience of academics, healthcare practitioners and policy makers. They asked Dr Conroy to provide more information and if they could be involved as a pilot/ evaluation site.
Year(s) Of Engagement Activity 2018
URL https://connected-communities.org/wp-content/uploads/2018/02/Catalyst-Project-Report-Funder-F-MacPha...
 
Description BAM 2018 Phronesis Workshop 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Workshop Brief:

As part of a 3 year AHRC funded project we have applied virtue ethics and an executive virtue concept named phronesis (practical wisdom) to data we collected from 131 Doctors and Consultants. We interviewed probably the most trusted profession in the world (medics) to find out what making ethically wise decisions means to them. The narratives we collected offered the composite ethical wisdom from a reasonable large group from the medical profession.

We found both a describable process and a deeper, more nuanced set of what we have called virtue continuums (VCs). We think that the findings are applicable to any context and leadership role and we can now offer a prototype process for workshop attendees to test out with their ethical dilemmas they bring to the workshop if they wish. Please ensure anonymity and confidentiality is protected when sharing your dilemmas.

All leaders have to make complex ethical decisions on a daily basis and have a vast (some might say overwhelming) array of guidelines, formularies and policies to draw upon and consider. However there are few practice based tools to either brief on the decision making process for any particular situation or to review decisions. Questions have rarely been asked as to how professionals are equipped morally (or otherwise) to navigate a chaotic world of practice rife with competing demands and relationships in order to come to decisions which contribute to the good of their immediate customers or service users, their communities and wider society. Here we offer a tool that we think could equip leaders and their peer group with a moral debating resource to make better ethical decisions. This is a briefing tool for use before, in and after action to help leaders in any discipline in their reflection on complex ethical decisions. Delegates have the opportunity to bring their decisions and associated ethical dilemmas and test out the tool to see if helps them reach an ethical decision. Bringing and working on an ethical dilemma is not compulsory - you may be interested in the research and policy dimensions rather than the practical application. Your feedback on the tool would be appreciated regardless.

Workshop Format - 4 stages - 90 mins
1. What is the purpose of arriving at a decision for the dilemma?
2. What are the concrete circumstances of the dilemma at hand?
3. What are the virtue continuums of relevance to the dilemma?
4. Can purpose be integrated with a staged virtue approach to arrive at a decision?

1.0 Introduction - 15 mins
1. Research methodology and findings - Presentation by MC
2. Watch episode 1 of the *Stilwell film series
2.0 Table groups - 15 mins
3. What are your ethical dilemmas/ decisions?
4. Select one from each table that they choose to work on
3.0 Plenary - stages 1&2 - 15 mins
5. Share an anonymised ethical dilemma/ decision from each table
6. What is the purpose in relation to the dilemma/ decision?
7. What are the concrete circumstances?
4.0 Table Groups - stage 3 - 20 mins
8. Episodes 4 or 5 viewing to show virtues emerging for J&D
9. What virtues (from the 15) would you say are relevant to your dilemma?
10. What other virtues seem relevant to resolving your dilemmas?
5.0 Table Groups - stage 4 - 15 mins
11. Use the 3 stage wheel of virtues to decide on actions.
6.0 Plenary - review the process and feedback - 10 mins
12. Can you see any wider application of the approach to other ethical dilemmas?
13. Any further feedback on the approach?

* The 'Stilwell Odyssey' is a series of short films to bring alive a consolidated set of 15 different virtues conveyed in the narratives from our research participants. The series is designed to be a moral debating resource and not 'this is how it should be done' so that the audience of medical students or people with a leadership role in a workshop have a stimulus to reflect and debate what they think is a virtuous approach to ethical decision making in their particular cases or generally.
Year(s) Of Engagement Activity 2018
URL https://www.bam.ac.uk/civicrm/event/info?id=3337
 
Description Birmingham South Central Clinical Commissioning Group - AGM 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact We set up a stall and delivered a talk at a local Birmingham Clinical Commissioning Group AGM which was held in a local community arts centre . There were approx. 20 people in the audience for our talk and overall a total of approx. 200 people attended the AGM and associated stalls and activities. This promoted our research to GPs and to members of the local community and led to some interesting conversations after the talk in the café drop in session. The presentation included the following information and questions:
Phronesis and the Medical Community

What does it mean to Doctors to make ethically wise decisions?

What are the virtues which come into play in making ethically wise decisions in medicine? How can the project sustain and build these virtues by designing educational resources?



Project Team led by Dr. M. Conroy: Ms. C. Hale, Dr. D Biggerstaff, Dr. R. Knox, Dr. A. Malik, Ms. C. Weir, Lt Comm. A. Brockie, Ms. J. Plumb, Dr. A. Hewison, Dr. C. Turner, Ms. D. Broomfield, and Ms. E. Balandyte

Follow us on Twitter: @Phronesis MC or visit:
http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/research/projects/2015/phronesis-and-the-medical-community.aspx
The follow up to this was to join a discussion at a stall in the cafe afterwards, to be interviewed for the project especially recently qualified doctors, to volunteer to be a member for a community focus group, to sign up for an invite to project workshops and use of the video series and finally a invite to follow the project on twitter.
Year(s) Of Engagement Activity 2017
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description British Academy of Management (BAM) Conference 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The PI presented a paper on the ethics of health reform leadership connected to approach used for the PMC research project. The PI also joined the Leadership and Leadership Development (L&LD) Special Interest Group (SIG) to talk about setting up a health and medical leadership ethics branch. The outcome was an agreement by L&LD SIG that an event at HSMC where our research can be presented along with research being done by other SIG members would be the next step.
Year(s) Of Engagement Activity 2017
URL https://www.bam.ac.uk/civicrm/event/info?id=3178
 
Description COMET 2018 Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Dr Mervyn Conroy was a member of a three person panel led by Professor Lauris Kaldjian who has written extensively on the theory of phronesis and its application to medical practice. Conroy presented the findings of his research and engaged in debate with the audience and panel members.
Year(s) Of Engagement Activity 2018
URL https://www.birmingham.ac.uk/facilities/mds-cpd/conferences/comet-2018/index.aspx
 
Description Coding Group Meetings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact The Coding Group meets once a month to analyse the data collected from the fieldwork and produce findings. We have had 15 meetings so far and we are leading up to presenting the final findings at the final workshop on 22 March 2018.
Year(s) Of Engagement Activity 2016,2017,2018
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Faculty of Medical Leadership in Management: What Next for Medical Leaders? 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Dr Mervyn Conroy presented his research findings to the conference including the film produced as a moral debating for UG and PG programmes.
Year(s) Of Engagement Activity 2018
URL https://www.fmlm.ac.uk/sites/default/files/content/resources/attachments/What%20next%20for%20medical...
 
Description Final Project Workshop on 22 March 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Next planned engagement event for Phronesis and the Medical Community is the Final Workshop on 22 March2018. The day is planned as follows:
Phronesis into Practice: Introducing new Medical Ethics -- Research Findings and a Teaching Resource

10.00 am Tea and Coffee
10.30 am Is Phronesis Important?
"As a Doctor, you can have all the knowledge in the world but to apply it well means you are using practical wisdomPhronesis"
10.45 am Update on project main findings: themes, virtue continuums and principles and intro to the new teaching resources
11.15 am Phronesis in the life of a clinician
11.30 am Core theoretical and applied elements of Phronesis
11.45 am Refreshments and group work: resonance with your experience
12.30 pm Plenary
1.00 pm Lunch
2.00 pm Matinee screening of the film series from the new teaching resource (including popcorn and refreshments)
4.00- 4.30 pm Next steps and close

Health practitioners have been under fire about their approach to ethical decision making since the 1960s and recent media scandals have not allowed practitioners, policy makers, patients and their communities to relax in this regard. This study has focussed on one practice community, doctors, and the meanings they associate with good decision making. The findings have revealed new insights into the subject and this final workshop will present those insights and gather feedback from a range of stakeholders to help us work with them for the common good in this highly challenging and contested area moving forward.

Phronesis or practical wisdom is a concept which advocates a way to make ethical decisions that are grounded in an accumulated wisdom gained through previous practice dilemmas and decisions. It can be considered as a leadership ability to make decisions that draw on experience from many previous practice situations and allows a leader to come to a wise decision when there seems to be many competing demands in any given situation. For a doctor it is a way to take all the virtues of relevance to any one patient decision into consideration and take action that brings the best outcome for that patient and their community. Ethical decision making can be complex with the "right" decision in one set of circumstances, for one patient not being the right decision for another. It is in effect an "executive virtue", which by keeping the stakeholders central to the process, allows ethical decisions to be executed in practice rather than simply discussing conceptual theoretical principles.
The Phronesis and the Medical Community project began in May 2015 with a 3 year Arts and Humanities Research Council (AHRC) grant. The project offers a unique methodology that combines virtue ethics (humanities) with a film based depiction of findings and analysis as part of a virtual community (arts). The latter forms a learning resource for medical schools and other CPD providers to help them with their medical ethics teaching. Although the resources are aimed at doctors at any stage of their career the resource could also be used by any health and social care discipline wishing to improve teaching associated with ethical decision making.
The project is led by HSMC but with strong collaborative input from across the University of Birmingham and from Universities of Warwick and Nottingham. Our primary research questions are:
1. What does phronesis (practical wisdom) mean to practitioners?
2. To what extent is phronesis cultivated, maintained and moulded over the educational and practice life of doctors in the UK?
3. To what extent can phronesis be promoted through educational and practice interventions?

Whilst there is a wealth of theoretical work on medical ethical decision making there has been very limited empirical work. Our literature review found only 14 studies of phronesis in healthcare of which nine were focussed on nursing. Our project has therefore been designed to address this gap in empirical research.
We have collected rich narrative by interviewing 140 Doctors from Birmingham, Warwick and Nottingham as they navigate their way through pre-clinical education, clinical training and into consultant or GP roles. We have complemented this with observations, reflective diaries, workshops and patient and public focus groups. The latter designed to understand wise decision making and its impact on trust in the medical profession from a patient and public perspective.
The methodology adopted is a hybrid that combines narrative based interview approaches with an arts and humanities analysis to produce an educational debating resource in the form of a video based odyssey. The odyssey is made up of six episodes that follow a consultant and GP as they navigate their way from medical school to experienced practitioners. Our analysis of the data identified a set of 'virtue continuums' which doctors tell us have a bearing on their decision making and which seem to change as they develop experience and practical wisdom. The odyssey collates the findings by using the narratives collected in an anonymised form to construct the storylines and scripts to convey the complexity of ethical decision making and where phronesis can be observed or not. The resource is not meant to be conveying 'this is how it should be done' but to convey the collective wisdom from our participants and allow students to debate the morality of each situation. The odyssey debating resource was designed and developed with the University of Cumbria who host 'Stilwell' (a fictional town in the UK) virtual community in which the odyssey storylines are based. The learning resource and associated materials will be piloted in our partner Medical Schools in early 2018 with further impact and engagement funding being sought to enable evaluation and expand the engagement and impact through UK medical schools and CPD providers in 2018/2019.
Follow us on Twitter: @Phonesis MC or visit: http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/research/projects/2015/phronesis-and-the-medical-community.aspx
Project Team led by Dr. M. Conroy: Ms. C. Hale University of Warwick, Dr. D Biggerstaff Warwick MDS, Dr. R. Knox Nottingham MDS, Dr. A. Malik HSMC, Ms. C. Weir HSMC, Lt Comm. A. Brockie UoB MDS, Ms. J. Plumb UHB NHS FT, Dr. A. Hewison UoB MDS, Dr. C. Turner CW NHS FT , Mr N Le Mesurier HSMC, Ms Gabrielle Thompson (Patient Representative) Mr James Liddiard ( HSMC) and the Stilwell team based at University of Cumbria.
Any questions or comments on research or if you would like to join us at the final workshop then please contact James Liddiard - J.Liddiard@bham.ac.uk
Year(s) Of Engagement Activity 2018
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Four focus groups convened during period June 2017 to November 2017, these were all located in various neighbourhoods in Birmingham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The four groups we met with were:

Womens yoga group ( 16 attendees)
Volunteers from a local Healthwatch ( 3 attendees)
Asian Womens exercise group ( 14 attendees)
Hospital Liver Patients Group ( 5 attendees)

A common topic guide was used for all the focus groups , the main focus being to understand more about what builds trust between patients and doctors from a patient and community perspective.

Topic Guide
What do you think helps a Doctor make a wise decision ?
How can we develop or enable wise decision making by Doctors ?
Have we as a society lost trust in Doctors ? and if we have what could help re-build that trust ?
Year(s) Of Engagement Activity 2017
 
Description GP Educators Conference 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact Presentation of findings to the conference by Dr Richard Knox
Year(s) Of Engagement Activity 2018
URL https://www.nwpgmd.nhs.uk/gp-educators-conference-2018
 
Description General Medical Council Manchester HQ presentation to policy makers 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presentation on the findings to Manchester and London HQs of the GMC as part of a consultation and analysis of their latest medical ethics guidelines.
Year(s) Of Engagement Activity 2018
URL https://www.gmc-uk.org/about/get-involved/consultations
 
Description Greenbelt: Ethics Branch of the Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The PI took part in a debate with Professor Charles Handy (World Renowned Leadership and Management Academic and Practitioner) on a seminar platform. The PI asked CH questions about how he thought the common good could be achieved in our society. The audience was a mix of ethics academics, medical practitioners, ministers and people interested in what it means to bring well-being to more in society and develop an ethos for us all to think about the common good (conference theme). CH's view was that we can't rely on governments or democracy to bring common good for all and instead that it has to be local leadership. He was asked what he meant by local leadership and he suggested that it should be a mix of people in our communities e.g. religious groups, schools, businesses, public sector organisations etc. that take a lead on bringing better quality of life for all. This argument fits well with the aims of the research project since we are focusing on one particular practice community - the medical community- and what it means to them to take up an virtue ethics in their decision making that brings well being for their patients and their community. We are not engaging with government or democracy but with three key medical schools in the midlands that are an important presence in the community and that are already using the findings of our research to influence medical practice in their region. We hope to widen the impact through all UK medical schools via a follow on impact and engagement project if it is approved by the AHRC.
Year(s) Of Engagement Activity 2017
URL http://www.greenbelt.org.uk/charles-handy-greenbelt-2017/
 
Description HSMC Faculty Day Presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Dr Mervyn Conroy gave a presentation of the findings to all staff members of the Health Services Management Centre.
Year(s) Of Engagement Activity 2018
URL https://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/res...
 
Description Institute Medical Ethics, Ethics education conference (St Catherine's , Oxford) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Medical ethics is un-controversially a core element of contemporary medical practice. It is a component of all medical school curricula. Ethics is also present, albeit in a 'patchy' manner in postgraduate medical education. Here it appears as a part of training newly qualified doctors, for doctors in specialist training and for continuing professional development. It appears as a refresher of principles underlying acceptable and praiseworthy practice, for purposes linked to professional roles such as leadership, education, and research, and as a survival skill for doctors who have to deal with every day issues. Postgraduate medical ethics education comes in myriad forms ranging from a seminar at a hospital grand round, to an array of postgraduate diplomas and higher degrees. This event will offer an opportunity for academics, educators and clinicians to better understand the purposes, nature and problems of postgraduate ethics education. Dr Steven Bolsin our international guest keynote speaker will address the connections between medical ethics and patient-safety.



The conference will be of interest to anyone involved in teaching medical or other healthcare students, whether academics or clinicians. The focus will be on raising awareness of the difficulties faced by certain sections of the community or patient populations, but also on providing resources and ideas for effective teaching about the issues to both clinical and pre-clinical students.

Students, and newly qualified doctors and healthcare professionals, who are interested in the issues addressed by the conference, and who want to explore the issues further are in attendance.
We presented a paper. Here is the abstract:Doctors, informed by evidence-based medicine, rely on their clinical/scientific knowledge to treat patients, and see it their duty to normalize patients' altered biochemistry and physiology. However, clinical decision-making is fraught with uncertainty, and scientific knowledge, though crucial, is often not sufficient to come to the right decision in particular cases. A patient is not only a body whose chemical imbalance requires readjustment; their body is not separate from their person, and that person has complex social facets. What does the patient prefer, what does the family want and what resources are available are some of the confounding factors which determine the application of their clinical knowledge.This raises challenges for doctors when deciding what is the right thing to do in this case. Practical wisdom (phronesis) is the ability to bring virtues to bear appropriately in medical practice. MacIntyre's neo-Aristotelean perspective on virtue ethics emphasizes the importance of the practice based peer community, and related disciplines, debating the appropriate ethical decision stance to take on the many different situations faced by the medical community.
Thus Phronesis, by promoting the good in morally difficult situations, helps clinicians to come to decisions that are ethically sound. We are conducting an empirical study - "Phronesis and the Medical Community"- to explore the acquisition and use of phronesis in medical communities. Using qualitative research methods, semi-structured interviews and observations, to collect data, analysis of the stories/experiences our participants narrated, was performed. Phase one is complete and though our participants were a mix of medical student and practicing doctors, this paper presents findings regarding foundation year and experienced doctors' perspectives on the support and development of ethical decision making when faced with (ethically) challenging situations.
An analysis of these narratives shows different themes about practice on the ground regarding support for doctors to make ethical decisions. Thus 1.what 'is' the practice that though acceptable, requires improvement. Some of the current practices are acceptable such as the emphasis on ethics in preclinical years (though some structured training in post registration years would be good too), informal learning amongst peers (though may perpetuate misunderstandings) and de-briefing sessions of hard skills.
2. What 'is' the practice that is preferred, and ought to be maintained. Doctors considered following practices as useful: discussing difficult cases and decisions by senior doctors who engage/interact with foundation year doctors, having regular de-briefing sessions on soft skills, guiding ethical decision-making through practical application and videos showing actual problems that occur in medical practice.
3. What 'is' the practice that is not preferred. Our cohort stated the following practices as not very useful: discussing cases on paper and not real-time, reflections in e-portfolios without directly addressing and discussing the difficulty of making a particular decision.
Conclusion: In order to meet the stakeholders' needs in this case post-registration doctors, it is essential to take their viewpoint on board when designing ethics training programmes. On this view the 'is' can inform what 'ought' to be.
(Aisha Y Malik, Mervyn Conroy, Catherine Weir, Health Services Management Centre, University of Birmingham).

This activity conducted at St Catherines College, University of Oxford on 5th June, 2017,was attended by 50/60 participants who came from all over the UK. The participants after 12.45pm were engaged in workshops which were held in three parallel streams: i): The UK Foundation-Years and Ethics Education. ii)UK Speciality training and Ethics Education. iii) Ethics education and Continuing Medical education.
A member of our research team attended this and, based on the analysed data from Foundation year doctors who participated in our research , presented the findings as a poster which were discussed at i) workshop 'The UK Foundation-year and ethics education.' the tile of the poster was :" Ethics Education : what 'ought' to be . The discussions captured a sense of the learners' needs, pedagogical approaches and opportunities /barriers for ethics education of/for doctors.
A policy maker from GMC, Head of Policy, Standards and Ethics Education and Standards Directorate, was made contact with and she was very interested in the research and will be. She wants to engage with us and will be sending a representative from GMC to discuss as to how to apply the learning to the future GMC programme of work especially with medical schools and training provided. A further contact was made with a Senior Lecturer in Medical Ethics, Curriculum Lead for Professional Practice Values and Ethics at Lancaster University and the PI subsequently met her at Lancaster to discuss future collaboration and use of the Stilwell learning package.
Year(s) Of Engagement Activity 2017
URL http://www.instituteofmedicalethics.org
 
Description Intercalated Seminar at Park House, HSMC for a group of 4/5th year medical students 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact Dr Mervyn Conroy ran a seminar/ workshop for 4th and 5th year medical students who were on a intercalated programme focusing on medical leadership.
Year(s) Of Engagement Activity 2019
URL https://www.birmingham.ac.uk/undergraduate/courses/med/health-management-leadership-intercalated-deg...
 
Description International Health Conference ( St Hugh's College Oxford) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This Oxford International Health Conference series brought together health researchers who aim to promote health and wellbeing through improved health services in Europe and around the world.

The 2017 global health conference was hosted at the University of Oxford. The aim of the event is to highlight the link between research and practice by gathering together a wide range of papers on health and health services research close to practice and/or policy. These cover the full range of allied disciplines including primary care, acute medicine, public health, psychiatry, paediatrics, and ageing as well as economics, psychology, statistics, social science and ethics, clinical trial design, health informatics and implementation research.

The world health congress series has been established by academics in Oxford and elsewhere and is open to health researchers, particularly those related to health services in the UK, Europe and beyond. This was an exciting new opportunity to develop research networks and encourage the uptake of research and evidence based innovations in all areas of science that contribute to health and wellbeing through better health services.

For the conference paper we presented the following:

Title: Phronesis and the medical community: initial findings
(Mervyn Conroy (Senior Research fellow) & Aisha Y Malik (Research fellow) HSMC, University of Birmingham,

Doctors rely on clinical data, medical science and their reasoning to make a clinical judgement regarding instituting a particular treatment for a particular patient. Clinical judgement, however , is plagued with uncertainty and further confounded by patient preference, family preference and resource availability.

We argue that in circumstances like these phronesis, practical wisdom that promotes the good in morally difficult situations, helps clinicians to come to right decisions. We are conducting an empirical study to understand what phronesis means to medical practice. Having completed phase one of our research, we present initial themes and findings regarding virtues and practical wisdom, its cultivation and development during the professional career of doctors.

(Doctors rely on clinical data and their reasoning to make clinical judgements regarding instituting treatment for a particular patient. Clinical judgement, however, is plagued with uncertainty and further confounded by patient preference, family preference and resource availability.

We argued that in such circumstances phronesis, practical wisdom that promotes the good in morally difficult situations, helps clinicians make right decisions. We are conducting an empirical study to understand what phronesis means to medical practice. Having completed phase one of our research, we present initial themes and findings regarding virtues and cultivating/developing practical wisdom during the professional career of doctors.)
The outcome of this was dissemination to an international audience of healthcare researchers.
Year(s) Of Engagement Activity 2017
URL http://www.globalhealthcongress.org/
 
Description Invite to present a seminar to all the Oxford University Medical Students and Tutors 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact DR Mervyn Conroy has been asked to present a lecture/seminar and workshop to the the undergraduate students and tutors at Oxford University Medical School in June and July 2019
Year(s) Of Engagement Activity 2019
 
Description Marketing Meeting Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact The Marketing Group has met bi-monthly over the last 12 months of the project. The aim is to decide how best to market the project and engage with media, medical schools, medical practitioners, policy makers, patients and the public. Already the group has gained ethics approval to use twitter as a social media presence for the project and spread the word globally about what is happening on the project. One idea has been to tweet quotes from the research data that might be helpful to other doctors to hear and respond to.

We hope to spread new understandings of the cultivation of phronesis in medical communities and its role in rebuilding public trust in the light
of many scandals will be of interest to healthcare researchers, educators, practitioners and policymakers. Specific value to
other AHRC programmes is expected through the hybrid social science and arts based methodology (Conroy et al 2018). The project aims to deliver
a return on the AHRC's investment by impacting on the medical and professional education of doctors as a community,
building stronger links between the medical community and the public and rebuilding public confidence in the medical
profession.
Year(s) Of Engagement Activity 2017,2018
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Operational Group Meetings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact The operational group meets once a month to review progress on each activity and ensure all objectives are being met. The group is chaired by the PI, Mervyn Conroy.
Year(s) Of Engagement Activity 2015,2016,2017
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Phronesis and The Medical Community Second Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Aims of the day:
Present the early findings
Gather feedback on direction of the research
Explore engagement and impact approaches associated with key findings
Early Stilwell storyline testing
Book chapter or video/ audio post of their ideas
About 30 people attended: a mix of academics, practitioners and policy makers in the field. The workshop looked a range of themes and issues associated with the project. These included: apprenticeships, best interests of patients or societal well-being or both, what the desired outcome for the project would be, use of the Stilwell Odyssey learning package, technology, making the film series look real, delivery methods including on line, face to face and others and who the audience would be. Out of the discussions came a real sense of the importance of the project to medical ethics. Supporting the medical community in medical education and through to CPD programmes was emphasised.
Year(s) Of Engagement Activity 2017
URL https://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/res...
 
Description Phronesis and the Medical Community First Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A half day workshop organised and facilitated by the investigators introduced the planned study, presented initial findings from the literature review and helped refine key
research questions and the design. All three partner medical schools were represented and related
NHS Trust involved plus academics and professionals from a range of related disciplines.

The aim was to refine the aims, objectives with an emphasis on 'pathways to impact' of outputs and
research questions. In addition, throughout the study the Steering Group will meet three times a
year, in order to direct and respond to the research. There was a second and there will be a final workshop including
participants from different academic disciplines including the social sciences, arts and humanities
as well as professionals e.g. social workers, representatives from health professional groups and
regulators such as the General Medical Council, medical Royal Colleges, British Medical
Association, Nursing and Midwifery Council, Royal Pharmaceutical Society and policy makers in
the field of medical education. One of the principal purposes of the workshops will be to examine
how the research findings and the co-produced video series can be widely disseminated and
encourage effective utilisation.
Year(s) Of Engagement Activity 2015
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Presentation of Research Findings to the Neuro-Rehabilitation Unit Royal Preston Hospital Lancashire Teaching Hospitals 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact Dr Mervyn Conroy presented the research findings and a future research proposal to Dr David Shakespeare who is the Divisional Medical Director for Medicine for Lancashire Teaching Hospitals at Preston Royal Hospital. Dr Shakespeare committed to partnering on the new project based on the presentation.
Year(s) Of Engagement Activity 2019
URL https://www.lancsteachinghospitals.nhs.uk/
 
Description RCGP Annual Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact Dr Richard Knox (Co-I) presented the research findings at the conference and a PMC research project stand was staffed by the research fellows.
Year(s) Of Engagement Activity 2018
URL http://www.rcgpac.org.uk/rcgp2018/
 
Description Steering Group Meetings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact In order to direct the research and facilitate pathways to impact for the beneficiaries a Steering Group was formed.

There are representative members from both beneficiaries and collaborators in order to maximise the potential up-take and
application of the research. Members of the Steering Group include each of the formal collaborative partners: medical schools and hospital trusts of Birmingham, Nottingham and
Warwick, Health Education England, and there is also be patient, medical student, consultant, GP on the Steering Group as well as academics and professionals from a range of related disciplines.

The Steering Group met four times in the first four months, with an initial workshop in
order to refine the aims, objectives with an emphasis on 'pathways to impact' of outputs and
research questions. In addition, throughout the study the Steering Group has been meeting three2 times a
year, in order to direct and respond to the research.
Year(s) Of Engagement Activity 2015,2016,2017,2018
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description Talk to Patient Participation Groups (PPG) chairs of Birmingham South Central CCG 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact The aim was to explore the role that phronesis plays in strengthening and sustaining bonds between the medical community and patients/ public
The research was presented to the group and feedback received on rebuilding public trust in medical practice in relation to the research project. The questions asked included: What do you think helps a Doctor make a wise decision ?
How can we develop or enable wise decision making by Doctors ?
Have we as a society lost trust in Doctors ? and if we have what could help re-build that trust ?
Out of this event the Chair of the CCG may attend the Faculty of Medical Leadership Management (FMLM) conference and 3 PPG chairs are coming to the the final workshop on 22 March 2018.
Year(s) Of Engagement Activity 2017
URL https://bhamsouthcentralccg.nhs.uk/get-involved/ppgs
 
Description The Transplant Lecture for the Decision Making (DEM) Module at University of Birmingham Medical School 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact Transplant lecture plus ethical decision making drawing on the findings from the Phronesis and the Medical Community project. The lecture was for 350 x 2nd year medical students.
Year(s) Of Engagement Activity 2019
URL https://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/res...
 
Description University of Birmingham Medical and Dental School (MDS) Away Day 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Undergraduate students
Results and Impact The following poster was presented at the away day:Phronesis and the Medical Community

What does it mean to Doctors to make ethically wise decisions?

An Arts and Humanities Research Council funded collaborative project led by the Health Services Management Centre at the University of Birmingham in partnership the Medical Schools of Birmingham, Warwick and Nottingham

What are the virtues which come into play in making ethically wise decisions in medicine? How can the project sustain and build these virtues by designing educational resources?





Project Team led by Dr. M. Conroy: Ms. C. Hale, Dr. D Biggerstaff, Dr. R. Knox, Dr. A. Malik, Ms. C. Weir, Lt Comm. A. Brockie, Ms. J. Plumb, Dr. A. Hewison, Dr. C. Turner, Ms. D. Broomfield, and Ms. E. Balandyte

Follow us on Twitter: @Phronesis MC or visit:
http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/research/projects/2015/phronesis-and-the-medical-community.aspx
Year(s) Of Engagement Activity 2017
URL http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/rese...
 
Description University of Birmingham Medical and Dental School and Ministry of Defence Event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Undergraduate students
Results and Impact Posters about the research project produced and used at this event.
Year(s) Of Engagement Activity 2017