Phronesis and the Medical Community: Follow on Impact and Engagement
Lead Research Organisation:
University of Birmingham
Department Name: Health Service Management Centre
Abstract
Through our 'Phronesis and the Medical Community' (PMC) dissemination activity undertaken to date, we know that currently no consensus exists across UK medical schools about the best way to teach and assess medical ethics. Some principally use lectures, others problem-based learning and interactive resources. In terms of assessment some medical schools use essays, others reflective work, Objective Structured Clinical Examinations (OSCES) and Multiple Choice Questions (MCQs), or a mixture of these methods. Therefore in order to impact on education we need a flexible and adaptable resource.
In addition, different medical schools allocate differing amounts of time to the teaching of ethics. Our project, PMC, has shown that ethical principles in terms of a wide variety of practice virtues are expressed by students, trainees and experienced practitioners through their experiential learning within a multi-disciplinary environment and clinical context, along with other clinical skills. These virtues are not applied or fully understood in medical schools or Continuing Professional Development (CPD) education. What we have also found is a significant vertical and horizontal fragmentation in the many medical practice virtues accounted for in the stories from our participants through the different career stage cohorts in the medical community.
Our aim is to apply the PMC findings in the form of a flexible, accessible and interactive resource, including teaching material beyond the three partnering University Medical Schools in the original project (Birmingham, Nottingham and Warwick) to other medical schools and CPD medical training providers across the UK. The outcome would be resources and capabilities that would improve ethical decision-making training and education for the wider medical community. The impact would be improved clinical outcomes, patient experience and trust in the medical profession, growing in the community as a whole.
We are currently producing a six-episode video serial drama connected to an existing health and social care virtual community called 'Stilwell' (the fictional town in which the community is based), which will enact the combined received wisdom (covering accounts of good and questionable practices) in the research findings from medical school to experienced consultant or GP (using professional actors). Along with this will be tutor notes to guide the use of the resource. Like previous Stilwell applications (for nursing and allied health professionals) it can be used as a safe placement resource by the medical schools and CPD providers we engage with on this project. It will allow medical students to interact with the ethical dilemmas depicted by the consultant and GP characters and have the moral debates about which course of action they think is appropriate for patients and society. It can also be used for CPD applications in the same way.
In summary the Stilwell moral debating resource and tutor notes will provide an opportunity to:
1. Give clinical context via accessible video and other media resources to the learning of medical ethics.
2. Provide a safe controlled placement/ environment with time for reflective learning.
3. Enable discussion around what should be taught and assessed in terms of medical ethical and start to generate a consensus as a basis for safe and effective clinical practice.
Project Design
We will engage with medical schools across the UK at three workshops to see how best to adapt the learning resources to fit with their needs.
The workshops will co-produce refined versions of the teaching package (video series and tutor notes) with:
a) Staff from the medical schools responsible for medical ethics.
b) Staff from CPD training providers to cover those from the other medical cohorts at career stages beyond medical school.
c) We would also involve medical education policy makers, leading practitioners and medical education leading academics.
In addition, different medical schools allocate differing amounts of time to the teaching of ethics. Our project, PMC, has shown that ethical principles in terms of a wide variety of practice virtues are expressed by students, trainees and experienced practitioners through their experiential learning within a multi-disciplinary environment and clinical context, along with other clinical skills. These virtues are not applied or fully understood in medical schools or Continuing Professional Development (CPD) education. What we have also found is a significant vertical and horizontal fragmentation in the many medical practice virtues accounted for in the stories from our participants through the different career stage cohorts in the medical community.
Our aim is to apply the PMC findings in the form of a flexible, accessible and interactive resource, including teaching material beyond the three partnering University Medical Schools in the original project (Birmingham, Nottingham and Warwick) to other medical schools and CPD medical training providers across the UK. The outcome would be resources and capabilities that would improve ethical decision-making training and education for the wider medical community. The impact would be improved clinical outcomes, patient experience and trust in the medical profession, growing in the community as a whole.
We are currently producing a six-episode video serial drama connected to an existing health and social care virtual community called 'Stilwell' (the fictional town in which the community is based), which will enact the combined received wisdom (covering accounts of good and questionable practices) in the research findings from medical school to experienced consultant or GP (using professional actors). Along with this will be tutor notes to guide the use of the resource. Like previous Stilwell applications (for nursing and allied health professionals) it can be used as a safe placement resource by the medical schools and CPD providers we engage with on this project. It will allow medical students to interact with the ethical dilemmas depicted by the consultant and GP characters and have the moral debates about which course of action they think is appropriate for patients and society. It can also be used for CPD applications in the same way.
In summary the Stilwell moral debating resource and tutor notes will provide an opportunity to:
1. Give clinical context via accessible video and other media resources to the learning of medical ethics.
2. Provide a safe controlled placement/ environment with time for reflective learning.
3. Enable discussion around what should be taught and assessed in terms of medical ethical and start to generate a consensus as a basis for safe and effective clinical practice.
Project Design
We will engage with medical schools across the UK at three workshops to see how best to adapt the learning resources to fit with their needs.
The workshops will co-produce refined versions of the teaching package (video series and tutor notes) with:
a) Staff from the medical schools responsible for medical ethics.
b) Staff from CPD training providers to cover those from the other medical cohorts at career stages beyond medical school.
c) We would also involve medical education policy makers, leading practitioners and medical education leading academics.
Planned Impact
The original research project was a collaborative partnership with three medical schools: Birmingham, Nottingham and Warwick, alongside their respective NHS Trusts. This original geographical restriction has enabled effective and efficient project management with an anticipated timely conclusion date with the delivery of a complete virtual community safe placement package (Stilwell), but we have discovered that there are many different forms of curriculum provision and different styles of pedagogy within UK medical schools as well as CPD providers. In addition the GMC is refining its learning outcomes on professional values and behaviours. In order to fully disseminate the findings of this research, the 'follow-on' part of the project would be specifically aimed at all UK medical schools and CPD providers as well as the GMC. By enhancing and adapting Stilwell so that it is able to be used by all UK Medical Schools and CPD providers, with differing pedagogical styles would in turn lead to improved facilitation of the accumulation of practical ethical wisdom within the medical undergraduate community as a national strategy. The original project was partly formulated in response to a general consensus that, post Francis Report (2013), learning resources to inculcate professional values were very much needed (Ham & Hartley 2013). Medical students will now have the opportunity to reflect upon their ethical actions in a safe space about the implications and also consider alternative ways of acting in specific and difficult clinical circumstances.
There would be two face to face and an online engagement workshops with the potential for networking opportunities. The virtual online workshop would be offered via Skype (or equivalent application) in order to include attendance from representatives of geographically distant medical schools and others with an interest in the field. The workshops' aims would not only be to promote the use and uptake of the virtual community safe placement package by UK medical schools, but would also allow evaluation, modification and addition to the virtual community resource to address the requirements of the above identified new stakeholders.
In order to evaluate the learning resources effectively, Pawson and Tilley's (1997) formative evaluation led approach and Kirkpatrick's (1994) model of evaluation would be utilised, focussing on levels 1-3 of evaluation. Level 1 evaluation would focus on the 'reaction' to this learning package; including assessing the uptake of resources by different medical schools, as well as monitoring attendance at workshops and 'on the day' feedback from both participants and organisers. Subsequently level 2 evaluation would focus on determining what 'learning' has taken place, by employing an on-line questionnaire platform post workshop; where all participants would be asked how they are using the new learning resource and what new knowledge, skills or insights they may have gained. Evaluation at level 3 would be a three month follow up, focussing on evaluating what impact learning has had on 'behaviour', i.e. teaching medical ethics. This assessment would include a further online questionnaire to all participants, and semi-structured interviews with a sample of participants from key institutions. This evaluation and feedback from workshop participants and stakeholders in medical education would also then lead to the refinement and modification of the original learning materials, to better meet the requirements of all medical school and post graduate medical education curricula. Realistically in the 12 months of the project we expect to be able to facilitate evaluation of levels one to three but level four will be left to the providers. This will help them take full ownership of the different approaches to medical education and use impact feedback to continuously improve their practice.
There would be two face to face and an online engagement workshops with the potential for networking opportunities. The virtual online workshop would be offered via Skype (or equivalent application) in order to include attendance from representatives of geographically distant medical schools and others with an interest in the field. The workshops' aims would not only be to promote the use and uptake of the virtual community safe placement package by UK medical schools, but would also allow evaluation, modification and addition to the virtual community resource to address the requirements of the above identified new stakeholders.
In order to evaluate the learning resources effectively, Pawson and Tilley's (1997) formative evaluation led approach and Kirkpatrick's (1994) model of evaluation would be utilised, focussing on levels 1-3 of evaluation. Level 1 evaluation would focus on the 'reaction' to this learning package; including assessing the uptake of resources by different medical schools, as well as monitoring attendance at workshops and 'on the day' feedback from both participants and organisers. Subsequently level 2 evaluation would focus on determining what 'learning' has taken place, by employing an on-line questionnaire platform post workshop; where all participants would be asked how they are using the new learning resource and what new knowledge, skills or insights they may have gained. Evaluation at level 3 would be a three month follow up, focussing on evaluating what impact learning has had on 'behaviour', i.e. teaching medical ethics. This assessment would include a further online questionnaire to all participants, and semi-structured interviews with a sample of participants from key institutions. This evaluation and feedback from workshop participants and stakeholders in medical education would also then lead to the refinement and modification of the original learning materials, to better meet the requirements of all medical school and post graduate medical education curricula. Realistically in the 12 months of the project we expect to be able to facilitate evaluation of levels one to three but level four will be left to the providers. This will help them take full ownership of the different approaches to medical education and use impact feedback to continuously improve their practice.
Organisations
- University of Birmingham (Lead Research Organisation)
- Royal College of General Practitioners (Collaboration)
- Ministry of Defence (Collaboration)
- University of Manchester (Collaboration)
- UNIVERSITY OF NOTTINGHAM (Collaboration)
- National Lottery (Collaboration)
- Lancaster University (Collaboration)
- UNIVERSITY OF BIRMINGHAM (Collaboration)
- Health Education England (Collaboration)
- University of Warwick (Collaboration)
- University of Cumbria (Collaboration)
- UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST (Collaboration)
Publications
Boyd, S.
(2022)
Can you learn to be wise?
in BMA Doctor
Conroy M
(2021)
Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors
in BMC Medical Ethics
Malik A
(2020)
Phronesis in medical ethics: courage and motivation to keep on the track of rightness in decision - making
in Health-Care Analysis
Malik AY
(2020)
Virtues and Phronesis: Making Decisions in the Clinical Context.
in The American journal of bioethics : AJOB
| Title | Learning practical wisdom in ethical decision making for patients and their communities |
| Description | Film series and accompanying app for doctors and other healthcare professionals to use as a dialogical learning resource to improve their ethical decision making for patients and their communities. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2021 |
| Impact | These are covered in the previous sections |
| URL | https://www.thephronesisfoundation.com |
| Title | Seven part film series: 'collective practical wisdom' for ethical decision making |
| Description | A seven part film box set depiction of the findings; the 'collective practical wisdom' of the research participants. It convey the stories told by the doctors interviewed and observed and shows two lead characters, a GP and Consultant, maturing in their ethical decision making approach. The film series shows them working their way up from medical students to experienced Consultant and GP and the ethical decisions 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 | 2019 |
| Impact | This moral debating resource along with the wisdom wheel app conveys the 'collective practical wisdom' of the research participants and provides an alternative and a complement to other medical ethics approaches such as deontology (using the guidelines/ rule book) and consequentialism (the end result is all that matters) that has impacted on medical decision making through four main areas: • Enabled medical and related healthcare professionals to cultivate phronesis (practical wisdom) in a way that improves their good/wise/ethical decision making. • Medical students and trainees gained early phronesis insights related to ethical decision making from using the resources. • Some medical schools have endorsed the research by including the resources into already very packed curricula as they can see the importance of the contribution. • Wider wellbeing impact from changes in medical decision-making practices plus a strong interest in the approach and use of the resources from other sectors/ organisations that influence national and international wellbeing. The feedback is that it 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. A commercial licence agreement means that there will be funding to update the film box set as required. 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 App 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 was developed by one of the research participants as part of the resources to be used alongside the video box set series. The process tool allows reflection in 3 stages (patient, bigger picture, self and team) to arrive at a decision using phronesis. |
| Type Of Art | Artistic/Creative Exhibition |
| Year Produced | 2019 |
| Impact | Ethical decision making in healthcare is under increased scrutiny due to endless media reports of healthcare scandals and its complexity has grown with demographic changes, lack of funding and higher public expectations. The sheer number of decision guidelines for doctors to follow has become unmanageable and according to a critique by Greenhalgh et al (2014) amounts to a crisis in evidence-based medicine. Calls to provide an alternative to guideline based ethical medical decision making have grown over recent years building on Dunne's (1993) philosophical argument that exposes the limits of technical reason and Tyreman's (2000) contextually relevant assertion of the correcting role of phronesis. In responding to those critiques and calls the original research (Conroy et al 2018) offers theory on the use of phronesis (practical wisdom) in medical decision-making. This tool along with film box set series used to convey the 'collective practical wisdom' of the research participants provides an alternative and a complement to other medical ethics approaches such as deontology (using the guidelines/ rule book) and consequentialism (the end result is all that matters) that has made an impact that includes the following: • Enabled medical and related healthcare professionals to cultivate phronesis (practical wisdom) in a way that improves their good/wise/ethical decision making. • Medical students and trainees gained early phronesis insights related to ethical decision making from using the resources. • Some medical schools have endorsed the research by including the resources into already very packed curricula as they can see the importance of the contribution. • Wider wellbeing impact from changes in medical decision-making practices plus a strong interest in the approach and use of the resources from other sectors/ organisations that influence national and international wellbeing. |
| URL | https://phronesis.medicloud.io |
| Title | Wisdom wheel app - PC version |
| Description | A PC app to support ethical decision making for doctors or other healthcare professionals. The app can be used alongside the film series as an UG PG or CPD educational resource or in practice before during or after the decision-making. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2019 |
| Impact | These are already covered in previous sections |
| URL | https://www.thephronesisfoundation.com |
| Title | Wisdom wheel app - smart phone version |
| Description | This product is in the design phase and is due to be prototyped in the first half of 2022 and then turned into full production version in last half of 2022. In addition to having the same features as the PC version it will also have an 'ethical hub' dimension which means that users can contribute their practical wisdom to the app for other users to benefit from. Thus the smart phone app becomes a growing collective phronesis (practical wisdom) store room that is accessible by any doctor or helathcare professional in the world and will support them in making good/wise/ethical decisions for patients and their communities. |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2022 |
| Impact | None as yet but hopefully some can be reported in the research fish entry for 2023. |
| URL | https://www.thephronesisfoundation.com |
| Description | This project produced a report which is listed in the publications sections (Malik et al 2020). Here is a brief summary taken from the abstract: The original 'Phronesis (practical wisdom) and the Medical Community' research (2015-2018) contributed theory of the virtues that the medical community in the UK practice by to make good/wise/ethical decisions for patients and their communities. A discovery process that draws on humanities (virtue ethics) and arts (film production) was vital in achieving that. The purpose of the follow-on 'Impact and Engagement' project (2018-2019) was to assess the impact of that contribution by evaluating its application in a series of pilots. Those pilots used the output of the research in the form of a film series, app and accompanying facilitation notes and applied them in medical undergraduate, postgraduate and CPD educational programmes. The materials were combined and used as a non-prescriptive 'moral debating resource' that convey the current 'collective practical wisdom' of the medical community interviewed and observed in order to stimulate reflection on ethical decision-making. The main research question of this project was to ask whether applying the research findings in this form contributed to cultivating or growing their phronesis at any stage in medical careers. A developmental dimension to the project in the form of a formative evaluation used the feedback from the pilots to update the resources from an 'alpha' to a 'beta' version. That refining process helped the resources become more understandable and helpful for participants to become more adept at making good/wise/ethical decisions for patients and their communities. The central argument made in this report based on the summative evaluation of the pilots is that using this arts and humanities based 'moral debating resource' from the original project does support the cultivation of phronesis at all career stages of medical practice and can be also be used to improve decision making in other healthcare practices. The four main areas of impact identified and reported on here are: • Enabled medical and related healthcare professionals to cultivate good/wise/ethical decision making • Medical students and trainees gaining early phronesis insights from using the resources • Medical policy bodies and CPD providers are now working with the research team on raising awareness of the resources with doctors through their systems. • Wider societal well-being impact via growing changes in medical decision making practices plus a strong interest from other sectors particularly in leadership decision-making Both projects were funded by the Arts and Humanities Research Council (AHRC). The importance of inter-professional collaboration to ethical decision-making was raised by the participants in the original research and created a strong call for further research. This combined with the social policy drivers associated with integrated healthcare and the lack of research on inter-professional ethical decision-making has led the research team to formulate an Inter-Professional Phronesis (IPP) research grant application to the AHRC. |
| Exploitation Route | We researched one practice, medical practice (arguably the most trusted practice in the world) and conveyed the collective ethos (practical wisdom) of their ethical decision-making. If their ethos is what makes doctors the most trusted profession in the world then their 'collective phronesis' represents humanity at its best. This latest project has found that it is possible to cultivate and spread phronesis within the medical practice by using a filmed version of their ethos as a moral debating resource. This research therefore opens the door for any profession in any country to do the same. Whether that be by using this project's medical practice 'collective practical wisdom' as a starting point or conveying their own as a stimulus for moral debate. If other professions also take part in inter-practice as well as intra-practice debate with a common purpose/good of bringing wider well-being for their communities and universal flourishing for people of all nations then the outlook for humanity is promising. We hope that this first step of proving that it is possible to spread and cultivate the ethos of humanity at its best within one profession is the first of many steps to bring wider well-being nationally and internationally. |
| 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,Pharmaceu |
| URL | http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/research/wisedecisionmaking |
| Description | Details of emerging economic and societal impact arising from the award that you are reporting on (including how it has evolved): The research findings are having wider societal impact in the UK. Three examples are described here. First, through the change in the way doctors make decisions for patients that also considers wider community well-being. This is an inherent feature of the appliction of practice virtue ethics/ phronesis theory as the source of moral debate (MacIntyre 1981). Second is through the ongoing work with doctors' professional bodies and CPD providers who have requested that the PI supports them with raising awareness of the resources through their systems. Third, the research has influenced the curriculum within HEIs for other healthcare disciplines e.g. students on a post-graduate MSc programme for Occupational Therapists (OTs) used the materials in their second year. The students fed back that the resources are applicable to their discipline and they wished they had covered them in the first year On the national and international stage the resources are also starting to impact on leaders in other sectors that have societal well-being responsibilities. The PI presented the original research at the International Studying Leadership Conference (ISLC) at the end of 2018 and interest from a number of other sectors has already commenced. Two examples are described here. First, interest from the UK Merchant Banking sector; an offer has been made to the PI to meet Merchant Banking advisors. The idea proposed is to develop a similar approach (arts and humanities research, film production and moral debate resource) tailored for their use. Their ethical decision-making is generally associated with multinational corporations and high net worth individuals and has considerable international impact. Typical decisions relate to international financing, underwriting, real estate, trade finance, foreign investment, consultation on trades and trading technology. Second, an advisor to the UK government's Department for International Development (DfID) who reviewed the resources on the project website thought their non-prescriptive nature means they are more likely to be embraced and used by DfID members. This has the potential to improve ethical decision-making to impact on the well-being of people in the countries supported by DfID. The DfID connection will progress with the writing of a paper tailored to their interests. Engaging other leaders from internationally influential sectors is expected to build in the same way as Merchant Banking and DfID. A summary of how the findings from your award are impacting the public, private or third/voluntary sectors, and elsewhere: Nurturing phronetic decision making using this resource has enabled doctors to cultivate their practical wisdom and improved their approach to complex ethical decision making. The impact and engagement evaluation research creates a case to expand the inclusion of narrative pedagogy by drawing on the film and app based resources in medical schools and CPD programmes. The implications is for the design and development of curricula in medical schools in particular in the ethics and communication domains where the evaluation indicates that these resources do play a part especially in small group discussions. The resources would also support trainee education and continuing professional development. With the interest shown by national policy bodies (e.g. HEE, GMC) we are continuing to discuss with them how the research can be integrated into medical ethics practice and education policy. In substantive educational applications the resources have been embedded into some Medical Schools' curricula. They are also currently being discussed with professional bodies (e.g. RCGP and RSM) via CPD workshops and raising wider awareness of the resources for their membership. Moving forward the plan is to establish a virtual community of trainers, tutors and lecturers who have used the resources to enable them to exchange ideas about how the resources can be used and improved. A further implication is to organise where they sit within curriculums and with the range of other materials and resources used in the teaching of related areas i.e. ethics, law, communication, etc. Challenges overcome to achieve impact One challenge was time - we did not always have time to get the resources fully integrated into packed medical undergraduate curricula. However, this issue was recognised by the programme directors and for example in the 2020 Birmingham Medical School 2nd year undergraduate programme time given for presenting the resources was doubled from that allocated in 2019. This follow on impact and engagement project has overcome the challenge of providing a measure of the added value to a practice community that tends to prefer quantitative data as it carried out a survey with pilot participants and tutors. The vast majority were positive about the resources and recommended that the resources support medical ethical decision making in a way that leads to better outcomes for patients and their communities. The quantitative findings were backed up by the qualitative data and gave specific details about what could be improved as well. This latter feedback led to a 'beta' version of the resources which overcame other challenges. The first of these was that the particpants wanted more background on the virtue ethics and phronesis concepts. Also that they wanted us to include a seventh episode that dealt with the ethical tensions between senior clinicians and senior managers. These were addreesed with reworking episode one and creating a new episode seven. Both of these are now available for people to download from the website once they sign the licence agreement. The licence agreement and signing process also presented a challenge for some of the resource users but this has been overcome by making the process simpler. This work leads the way in terms of creating a strong case to understand the different ethical perspectives of healthcare disciplines beyond the medical community; their driving purposes and how they interact in situations that require collaborative decision-making between professions. Inter-professional group working is recognised as a central component of ensuring that people and families experience more integrated care but at present there is little research regarding the ethical aspects and in particular the virtues of inter-professional practice that lead to good and wise decision making. This greater understanding will enable health and social care services prepare and support professionals for these new collaborative arrangements and improve outcomes for people and communities. To this end a Bilateral Anglo-German comparative study has been submitted to the AHRC and Deutsche Forschungsgemeinschaft (DFG) on Inter-Professional Phronesis (IPP) in Mental Health Services. The spin out organisation The Phronesis Foundation has been established and co-located at the Health Innovation One Campus at Lancaster University. This has already led to the RCGP NW Chair requesting TPF to run a webinar for all its members in the NW and the HRA requesting a review of its ethical decision making. Both these new developments are ongoing (March 2021) and will be fully reported on in the next RF submission in 2022. Interest in the spin out applications has also come from the Merchant Banking sector and again if this develops it will be reported on in the next RF submission. International impact is also expected from the TV programme production which is planned for screening in 2022. |
| First Year Of Impact | 2021 |
| Sector | Communities and Social Services/Policy,Education,Healthcare |
| Impact Types | Cultural,Societal,Economic,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 | ESRC Festival at University Hospitals Birmingham NHS Trust - Queen Elizabeth Hospital Site |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The impact is to improve the way doctors make good/wise/ethical decisions for patients and their communities |
| URL | https://esrc.ukri.org/public-engagement/festival-of-social-science/about-the-festival/ |
| 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 | General Medical Council |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| 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 | HEE Enhance Programme |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | As with other CPD programmes we have delivered we expect the training to impact on ethical decision making practice for healthcare professionals involved in the HEE Enhance programme across the UK. The knock on impact is wider wellbeing for patients and their communities. |
| URL | https://www.hee.nhs.uk/our-work/enhancing-generalist-skills |
| Description | HEE Enhance Programme |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | As with other CPD programmes we have delivered we expect the training to impact on ethical decision making practice for healthcare professionals involved in the HEE Enhance programme across the UK. The knock on impact is wider wellbeing for patients and their communities. |
| URL | https://www.hee.nhs.uk/our-work/enhancing-generalist-skills |
| 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 | Royal College of General Practitioners (RCGP) NW Chair requested CPD Introduction Webinar for all members in the NW |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The impacts already established are as listed below and this webinar will focus on providing CPD to GPs in the NW initially. • Enabled medical and related healthcare professionals to change their approach to ethical decision making for patients and the wider community by cultivating phronesis. • Embedded into medical education allowing students and trainees to learn from the research output of 'collective practical wisdom' for ethical decision making. It has transformed the way medical ethics is approached and taught in medical schools, post graduate and CPD programmes. • Influenced policy groups such as the RCGP, GMC, HEE and DfID. Including policy guidance on cultivating practical wisdom and its associated virtues across the broad spectrum of healthcare professionals will help advance patient and community well-being • UK societal impact by improving community well-being and is also starting to impact on medical education and government leaders in other countries. |
| Description | Bham MDS DEM Tutorial: Cultivating Phronesis (Practical Wisdom) in Ethical Decision-Making |
| Amount | £400 (GBP) |
| Organisation | University of Birmingham |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 03/2023 |
| Description | Future ethics review model options development |
| Amount | £5,500 (GBP) |
| Organisation | Deloitte Touche Tohmatsu |
| Sector | Private |
| Country | United States |
| Start | 01/2021 |
| End | 05/2021 |
| Description | MD967 - What Makes a Good Teacher? - Cultivating Phronesis (Practical Wisdom) in Decision-Making |
| Amount | £200 (GBP) |
| Funding ID | MD967 |
| Organisation | University of Warwick |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 03/2023 |
| Description | Medical and Health sector Marketing and communication strategy support internship (ID: 14432) |
| Amount | £3,557 (GBP) |
| Funding ID | 14332 |
| Organisation | Lancaster University |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 09/2021 |
| End | 02/2022 |
| 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 |
| Description | RCGP - Phronesis Seminar - NW Regional Faculty |
| Amount | £300 (GBP) |
| Funding ID | https://rcgp.my.site.com/s/lt-event?id=a1U1i000001TrkfEAC&site=a0d0Y00000AeOP6QAN |
| Organisation | Royal College of General Practitioners |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 03/2021 |
| Title | Fully developed arts and humanities research approach that can produce collective practical wisdom (phronesis) applied to ethical decision making for any practice |
| Description | The research tool is a combination of applied arts (film production) and humanities (neo-Aristotelian) practice virtue ethics philosophy. It has already produced the collective practical wisdom of what it means to doctors to make ethically wise decisions for patients and their communities. This has been evaluated and found to make a positive difference to medical ethical decision making. The research tool and methods could be applied to any practice and we are currently developing the research proposals to apply the research tool and methods to practices in mental health services in the UK and Germany and to the care system professions who support the mental health of children and young people under their care. The approach is published in Conroy et al (2021). |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2021 |
| Provided To Others? | Yes |
| Impact | The approach has already impacted on the medical profession in the UK and we hope to expand this to other doctors in the UK as detailed in other sections of this return. |
| URL | https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-021-00581-y |
| Title | Novel hybrid research methodology to study phronesis |
| Description | The methodology developed for this project (Conroy et al 2018) provides a social science and arts based hybrid to undertsand the issues of phronesis to medical professionals (or leadership disciplines in any context for that matter) in order 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). We have also produce a decision making briefing and debriefing tools and resources. 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 is 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 ea |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2018 |
| Provided To Others? | Yes |
| Impact | Two of the most most notable impact examples are first, interest from the UK Merchant Banking sector and an offer has been made to the PI to meet Merchant Banking advisors. The idea proposed is to use a similar methodological approach (research, film production and moral debate resource) tailored for their use. Their ethical decision-making is associated with multinational corporations and high net worth individuals and has considerable international impact. Typical decisions involve international financing, underwriting, real estate, trade finance, foreign investment, consultation on trades and trading technology. The second example, a senior advisor to the UK government's Department for International Development (DfID) who reviewed the resources on the project website thought their non-prescriptive nature means they are more likely to be embraced and used by DfID members. This has the potential to improve ethical decision-making to impact on the well-being of people in the countries supported by DfID. These include Somalia, Nigeria, South Sudan, Congo, Syria, Iraq, Yemen, Afghanistan, Pakistan and Rohingya. The advisor has already discussed the use of the resources with the DfID members. He said 'This looks really interesting and I am sure that [UK government cabinet minister] would go for this. His bookincludes a lot about this type of knowledge that he says is missing' The DfID connection will progress with the co-authoring of a paper (with the advisor taking a lead) tailored to the interests of the members and then presented at one of their meetings. A great deal of national and international interest has been shown in the methodology and the PI, Dr Mervyn Conroy, has been approached by academics from the UK and 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. The methodology is defined in the final report but will also be a journal publication that 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 was created by one of our research participants and 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 | Collective practical wisdom dataset to facilitate ethical decision-making for doctors |
| Description | The model consists of 15 virtue continuums and companion app which allows the virtues to be applied in stages. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2021 |
| Provided To Others? | Yes |
| Impact | The model, now conveyed in film series and app resources has already impacted on the medical community in the UK through UG, PG and CPD programmes. The approach to using the resources is best discussed with The Phronesis Foundation CIC (https://www.thephronesisfoundation.com) as they are the official not for profit research spin out organisation that has been set up to support doctors and other healthcare professionals with applying the resources to support their ethical decision making. |
| URL | https://www.thephronesisfoundation.com |
| Title | Phronesis and the Medical Community Follow on Impact and Engagement Data |
| Description | The original 'Phronesis (practical wisdom) and the Medical Community' research (2015-2018) contributed theory of the virtues that the medical community in the UK practice by to make good/wise/ethical decisions for patients and their communities. A discovery process that draws on humanities (virtue ethics) and arts (film production) helped achieve that. The purpose of the follow-on 'Impact and Engagement' project (2018-2019) was to assess the impact of that contribution by evaluating its application in a series of pilots. Those pilots used the output of the research in the form of a film series, app and accompanying facilitation notes in medical undergraduate, postgraduate and CPD educational programmes. The materials were combined and used as a non-prescriptive 'moral debating resource' that convey the current 'collective practical wisdom' of the medical community interviewed and observed in order to stimulate reflection on ethical decision-making. The main research question of this project was to ask whether applying the research findings in this form contributed to cultivating or growing their phronesis at any stage in medical careers. A developmental dimension to the project in the form of a formative evaluation used the feedback from the pilots to update the resources from an 'alpha' to a 'beta' version. That refining process helped the resources become more understandable and helpful for participants to become more adept at making good/wise/ethical decisions for patients and their communities. In summary therefore the data has three elements: 1. Formative evaluation data from all events 2. Summative evaluation data from the pilots 3. 'Beta' version of the resources as a film box set, app and notes that convey the original research findings plus the formative feedback as a moral debating resource |
| Type Of Material | Database/Collection of data |
| Year Produced | 2020 |
| Provided To Others? | Yes |
| Impact | The central argument made in the final report (Malik et al 2020) based on the evaluation of the pilots is that using this arts based 'moral debating resource' from the original project and modified to a 'beta' release does support the cultivation of phronesis at all career stages of medical practice and can be also be used to improve decision making in other healthcare practices. Notable impact areas include the following: • Enabled medical and related healthcare professionals to cultivate phronesis (practical wisdom) in a way that improves their good/wise/ethical decision making. • Medical students and trainees gained early phronesis insights related to ethical decision making from using the resources. • Some medical schools have endorsed the research by including the resources into already very packed curricula as they perceive the importance of the contribution. Formal endorsement application with professional bodies is in progress. • Wider wellbeing impact from changes in medical decision-making practices plus a strong interest in the approach and use of the resources from other sectors/ organisations that influence national and international wellbeing e.g. Merchant Banking and the UK Government's Department for International Development. Further potential impact: We researched one practice, medical practice (still the most trusted practice in the UK and possibly the world along with nurses) and conveyed the collective ethos of their ethical decision-making. If this ethos is what makes doctors the most trusted profession in the world then their 'collective phronesis' arguably represents humanity at its best. This latest project has found that it is possible to cultivate and spread phronesis within the medical practice by using a filmed version of their ethos as a moral debating resource. This research therefore opens the door for any profession in any country to do the same. Whether that be by using this medical practice 'collective practical wisdom' as a starting point or conveying their own as a stimulus for moral debate. If other professions also take part in inter-practice as well as intra-practice debate with a common purpose/good of bringing wider wellbeing for their communities and universal flourishing for people of all nations then the outlook for humanity is promising. We hope that this first step of proving that it is possible to spread and cultivate the ethos of humanity at its best within one profession is the first of many steps to bring wider wellbeing nationally and internationally. |
| URL | https://www.birmingham.ac.uk/wisedecisions |
| 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 box set as an 'alpha' version was 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 subsequent impact and engagement follow on project generated 72 enquiries from medical schools and CPD providers to use the resources at all educational levels. A separate report (Malik et al 2020) on the evaluation of the resources is now available. |
| URL | http://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/news... |
| Title | What does it mean to doctors to make good/wise/ethical decisions for patients and their communities |
| 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 what it means to them to make context-dependent, localised, 'good' and 'wise' decisions for patients and the wider community. It also contains stories they told of what they considered to be unwise decisions. Added to this is 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 of the main report - Conroy et al 2018) is 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 | The four main areas of impact from the use of this database are: -Enabled medical and related healthcare professionals to cultivate phronesis (practical wisdom) in a way that improves their good/wise/ethical decision making. -Medical students and trainees gained early phronesis insights related to ethical decision making from using the resources. -Some medical schools have endorsed the research by including the resources into already very packed curricula as they perceive the importance of the contribution. Formal endorsement application with professional bodies is in progress. -Wider wellbeing impact from changes in medical decision-making practices plus a strong interest in the approach and use of the resources from other sectors/ organisations that influence national and international wellbeing e.g. Merchant Banking and the UK Government's Department for International Development. Our methodology and methods including the the virtue continuum model and arts based virtual community analysis have already been requested for replication in the Merchant Banking sector, the UK Government Department for International Development and 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 Defence Medical Rehabilitation Centre, Headley Court, Surrey |
| Organisation | Ministry of Defence (MOD) |
| Department | Royal Navy |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | Dr Mervyn Conroy has overall responsibility for the project's running and design. This includes leading and managing the Co-Is and Research Fellows. He has allocated Co-Investigators specific responsibilities in accordance with their areas of expertise. They will also have input into all aspects of the research, impact and management activities - these include extensive fieldwork, continuous literature reviews, in-depth analyses and the conversion of the findings into a film production. |
| Collaborator Contribution | Lieutenant Commander (Lt Cdr) Alan Brockie the Business Manager at the Defence Medical Rehabilitation Centre at Headley Court, Surrey, has provided support to the first project as a Co-I and has continued to support the Follow on Impact and Engagement project by attending Ops and SG meetings at HSMC. His experience of making ethical decisions on the front line in a range of military theatres of war continues to provide invaluable insights at the extreme end of ethical decision making for medics.He has contributed to data collection through conducting interviews and the analysis of the data. He has also supported project publications as a co-author. His background is in healthcare law and ethics. |
| Impact | Film production moral debating resources and publications. |
| Start Year | 2015 |
| Description | Collaboration between Health Services Management Centre and Department of Social Policy and Social Work at University of Birmingham |
| Organisation | University of Manchester |
| Department | Department of Social Policy and Social Work |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Three main activities were carried out in partnership: 1) Scoping review 2) Literature review: examining knowledge and debate concerning "communities" in health and social care. 3) Networking/Collaborative Activity: |
| Collaborator Contribution | The scoping review mapped out: Conceptualisations and meanings of 'community' in health and social care: what is being invoked by "community" in the health and social care domain? Personalisation and health and social care communities: what is the relationship between personalised policy and practice, and communities? Connectivity within and between health and social care communities in the context of policy: how does connectivity function in changing governance and user community contexts? The methods used were: Literature review: examining knowledge and debate concerning "communities" in health and social care. Networking/Collaborative Activity: 1. Workshop learning event to identify key communities in the lived experience of participants to inform the literature review. 2. A seminar event with invited participants to present findings and identify future directions in "health and social care communities" research. |
| Impact | Conroy, M, Clarke, H. & Wilson, L. (2012) Connected Health and Social Care Communities. AHRC final report http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-and-social-care-communities/ Professor Robin Miller, Head of Department, Social Work & Social Care and Co-Director, Centre for Health & Social Care Leadership has taken up a Co-I role and agreed to collaborate on a Bilateral Anglo-German comparative study of 'Inter-Professional Phronesis' in mental health services as part of a new submission to the AHRC. |
| Start Year | 2011 |
| 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 an Honorary at Birmingham and now an Associate Professor in Medical Law and Ethics at Warwick. She 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. The Birmingham Medical School has been piloting the research resources in their undergraduate programme in 2019 and 2020 |
| 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. Both Cathy Hale and Sharon Buckley, Senior Lecturer in Medical Education, Institute of Clinical Sciences, College of Medical and Dental Sciences.have taken up Co-I roles and agreed to collaborate on a Bilateral Anglo-German comparative study of 'Inter-Professional Phronesis' in mental health services as part of a new submission to the AHRC. |
| 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. The latest collaboration is that Richard Knox has been registered as the GP trainer approval for programme accreditation from the RCGP. |
| 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. Led 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 allowed them to pilot the Stilwell learning resourcewith their students. It also allowed 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 disseminated 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 disseminated 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. Associate Professor Cathy Hale, Post-graduate Academic Lead, Warwick Medical School, has taken up a Co-I role and agreed to collaborate on a Bilateral Anglo-German comparative study of 'Inter-Professional Phronesis' in mental health services as part of a new submission to the AHRC. |
| Start Year | 2015 |
| Description | Collaboration between the Health Services Management Centre and University Hospitals Coventry and Warwickshire |
| Organisation | University Hospitals Coventry and Warwickshire NHS Trust |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Dr Mervyn Conroy has overall responsibility for the project's running and design. This includes leading and managing the Co-Is and Research Fellows. He has allocated Co-Investigators specific responsibilities in accordance with their areas of expertise. They will also have input into all aspects of the research, impact and management activities - these include extensive fieldwork, continuous literature reviews, in-depth analyses and the conversion of the findings into a film production. |
| Collaborator Contribution | Dr Chris Turner is a Senior A&E Consultant at UHCW NHS Trust and was a Co-I on the first project and is a Co-I on the Follow on Impact and Engagement project.Turner provides specialist expertise on ethical decision making at the sharp end of health and social care and uses his network of contacts to support access, build rapport and understanding and day-to-day responsibilities. He has also provided support to the analysis and engagement for dissemination activities. |
| Impact | Turner has contributed to the film production moral debating resource output and a range of publications. |
| Start Year | 2015 |
| Description | Health Services Management School at University of Birmingham and the University of Cumbria:Film Series and TV programme proposal |
| 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. The latest collaboration (March 2021) is with the Arts Institute at Cumbria to produce a TV programme with planned funding from the Wellcome Trust. |
| 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 |
| Description | The Phronesis Foundation (TPF) and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust |
| Organisation | University Hospitals Coventry and Warwickshire NHS Trust |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | TPF have now formed a collaboration with UHCW R&D that has led to a new NIHR HS&DR Research Award application |
| Collaborator Contribution | The R&D department at UHCW was the leading NHS organisation for the submission and they coordinated all the costings. |
| Impact | Ditto the entry here for the new collaboration between TPF and Lancaster University |
| Start Year | 2020 |
| Description | The Phronesis Foundation and Health Education England (HEE) |
| Organisation | Health Education England |
| Department | Health Education North West |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | Following the publication of the article in the British Medical Association's Doctor journal which mentions Dr Mervyn Conroy and the Phronesis and the Medical Community research he was contacted by HEE NW Associate Dean. They want to run a similar intro CPD webinar to that delivered for the RCGP for doctors in the NW. NW HEE oversees postgraduate medical education and training with a responsibility for over 7,000 trainees to ensure they are confident in providing high quality patient care, supported by excellent trainers and underpinned by the GMC's standards for medical education and training. |
| Collaborator Contribution | They agreed to contact the national HEE Deputy Dean and CPD Lead to discuss a plan for setting up an intro webinar. |
| Impact | The main outcome is that after the first meeting between the PI and the Associate Dean they were keen to plan for us to be included in their Enhance programme. We are now delivering two CPD sessions in 2023 as part of the Enhance programme: one is a virtual intro for the national Enhance team organised with the Education & Training Project Manager, Education Reform Programme Directorate of Education & Quality (National) and another is full CPD session based in Cheltenham with a group of doctors on the Enhance programme. |
| Start Year | 2022 |
| Description | The Phronesis Foundation and Lancaster University |
| Organisation | Lancaster University |
| Department | Faculty of Health and Medicine |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | From October 2020 the IP rights for the research know how and the resources (film series, app and the CPD approach) have been formally transferred to a new charity called 'The Phronesis Foundation (TPF)' which is co-located at the new Health Innovation One campus, Faculty of Health and Medicine, Lancaster University. All future collaborations on the spin out work are therefore with TPF rather than HSMC, UoB. |
| Collaborator Contribution | They contributed office space, promotion of the TPF brand and spin out offerings and engagement with all relevant health and social care organisations in the region. The latest collaboration element in 2023 is with the Management School to develop a new proposal to be submitted to The National Lottery, Reaching Communities Fund. This will be a rework of a previous submission for which TPF received very positive feedback and suggestions on how to improve. |
| Impact | The first outcome to date has been a NIHR HS&DR submitted award application to research inter-professional/ integrated care ethical decision making for young people and adolescents associated with the care system. The collaboration is fully multi-disciplinary and has been co-ordinated by the Engagement Lead for the HI1 centre. The disciplines they involved include: Academic departments at Lancaster: Management School Social Work NHS organisations: University Hospitals GP Practices CCGs County Council: Social Services The collaboration is still ongoing with all the practitioner organisations and academics from Warwick now taking the lead on the Mental Health components to the proposal. The collaboration with the Emeritus Professor, Management School is from the Department of Entrepreneurship and Strategy. This is associated with their spin out 'Wellbeing Economy' work and they plan to galvanise support with the social impact / wellbeing group as part of a NHS primary services led initiative they are involved with. |
| Start Year | 2020 |
| Description | The Phronesis Foundation and Royal College of GPs |
| Organisation | Royal College of General Practitioners |
| Department | Quality Improvement Division (RCGP) |
| Country | United Kingdom |
| Sector | Charity/Non Profit |
| PI Contribution | Running an Introduction Webinar for the RCGP NW Faculty Lead as CPD to support cultivating practical wisdom (phronesis) for a group of GPS who attended the webinar. |
| Collaborator Contribution | The RCGP organised the promotion and administration of the event. |
| Impact | Two main outcomes: 1) The evaluation feedback for the intro webinar was very positive and has led to the central RCGP CPD Lead applying for funding to run further webinars as learning sets for GPs across the country. 2) It has also led to another RCGP regional faculty CPD lead contacting The Phronesis Foundation with the intention of organising similar events specifically for their region. |
| Start Year | 2021 |
| Description | The Phronesis Foundation and The National Lottery |
| Organisation | National Lottery |
| Country | United Kingdom |
| Sector | Private |
| PI Contribution | Full proposal produced and submitted to the Reaching Communities funding stream in late 2022. |
| Collaborator Contribution | Positive feedback received along with comments to improve and help the award be successful. |
| Impact | Further collaboration with Lancaster University Emeritus Professor to produce a joint proposal that will address all the comments received form TNL. |
| Start Year | 2022 |
| Description | The Phronesis Foundation and University of Birmingham Medical and Dental Sciences College |
| Organisation | University of Birmingham |
| Department | College of Medical and Dental Sciences |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | After successfully delivering lectures based on the research in March 2019, 2020, 2021 & 2022 on Decision Ethics to the MBChB programme (core and intercalated) The Phronesis Foundation was invited to expand the teaching to deliver an experiential seminar tutorial on 6 March 2023. This contributes to the DEM (Decision Ethics Module) for all 450 2nd year students on the main Medicine and Surgery MBChB programme. |
| Collaborator Contribution | The Phronesis Foundation provided two Directors and two Associates to deliver the tutorial in four separate lecture theatres with 112/3 students in each room. |
| Impact | The feedback on the day was very positive and The Phronesis Foundation has already been asked to deliver and extended version of the tutorial in 2024. In addition, for 2023 onwards TPF will be contributing to the examinable content in the form of Multiple Choice Qs and the Single Answer Qs for the MBChB Y2 Foundations 4 Decision Making Component. |
| Start Year | 2020 |
| Description | University of Birmingham, The Phronesis Foundation and University of Warwick Medical School |
| Organisation | University of Warwick |
| Department | Warwick Medical School |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We have co-produced two more research proposals as a follow on to the original AHRC funded Phronesis and the Medical Community awards: 1) AHRC Standard Researcher Led Call - 2) NIHR HS&DR In February 2022 and 2023 we also delivered an experiential seminar as part of their MD967 module for the Masters in Medical Teaching called 'What makes a good Teacher?' by drawing on the research and resources to allow the experienced medics on the programme to cultivate phronesis (practical wisdom) in their ethical decision making. |
| Collaborator Contribution | They have been fully involved in the proposals' design and writing of the two proposals: AHRC Standard Call: Phronesis and Mental Health (MH) Inter-Professional Ethical Decision-Making NIHR HS&DR 135058 Research Proposal: To better engage children and young people (CYP) associated with the care system with support to improve their mental health (MH): How might an understanding of the role of CYP narratives in interprofessional decision-making lead to better engagement by CYP in MH care and support processes? The teaching contributions were solely delivered by Dr M Conroy, Director and Dr Aisha Malik, Associate from the Phronesis Foundation. |
| Impact | Both the above proposals were submitted to earlier calls in 2021 to the same funders and feedback received from peer reviewers. All that feedback was incorporated and submitted to the latest round of these calls. The teaching contribution was evaluated in 2022 and we are invited to return in 2023 and expect to be invited back in 2024. |
| Start Year | 2020 |
| Title | An approach to cultivate phronesis in the medical discipline and any other discipline. |
| Description | This is a combined version of the whole process that has been developed over the two AHRC funded projects and includes the full methodology which is outlined in Malik et al (2020) plus the following key components: 1) Virtue Continuum Modelling 2) Virtual Medical Community Video Series (box set) and other associated media 3) Teaching notes to go with the above 4) Process tool (wisdom wheel app) 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. We researched one practice, medical practice (still the most trusted practice in the UK and possibly the world along with nurses) and used this combined approach to convey the collective ethos of their ethical decision-making. If this ethos is what makes doctors the most trusted profession in the world then their 'collective phronesis' arguably represents humanity at its best. The impact and evaluation project found that it is possible to cultivate and spread phronesis within the medical practice by using a filmed box set version of their ethos as a moral debating resource. This research, as a complete package, therefore opens the door for any profession in any country to do the same. Whether that be by using this medical practice 'collective practical wisdom' as a starting point or conveying their own as a stimulus for moral debate. If other professions also take part in inter-practice as well as intra-practice debate with a common purpose/good of bringing wider wellbeing for their communities and universal flourishing for people of all nations then the outlook for humanity is promising. We hope that this first step of proving that it is possible to spread and cultivate the ethos of humanity at its best within one profession is the first of many steps to bring wider wellbeing nationally and internationally. IPR and patenting of the outputs have been transferred to The Phronesis Foundation which is located at Health Innovation One at Lancaster University. |
| IP Reference | |
| Protection | Trade Mark |
| Year Protection Granted | 2019 |
| 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. The IP was formally transferred to The Phronesis Foundation located at Health Innovation One, Lancaster University. |
| IP Reference | |
| Protection | Trade Mark |
| Year Protection Granted | 2020 |
| Licensed | Yes |
| Impact | Licencing of the research output materials as intellectual property in the form of the Stilwell video series and the accompanying tutor resources. |
| Title | Support to doctors and other healthcare professionals in making good/wise/ethical decisions for patients and their communities. |
| Description | Medical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an 'executive virtue', offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians. |
| IP Reference | |
| Protection | Trade Mark |
| Year Protection Granted | 2020 |
| Licensed | Commercial In Confidence |
| Impact | The UK medical community are now through the publications in BMC Medical Ethics and BMA Doctor starting to ask for more support to use the discovery. RCGP has already applied the resources with their membership (50,200 GPs) and Health Education England want to do the same. The Phronesis Foundation CIC is supporting both of those organisations with the application. |
| Title | Wisdom wheel app 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 app was produced by one of the research particpants and 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 UG, PG and CPD programmes. Together they offer a very powerful moral debating resource for practitioners at all levels to help them improve their wise decision making. A description of the tool and how it is applied is contained in the final report for the Impact and Engagement follow on project (Malik et al 2020) |
| IP Reference | |
| Protection | Trade Mark |
| Year Protection Granted | 2018 |
| Licensed | Yes |
| Impact | The specific impact areas have already been covered in other RF entries. 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. A licence agreement along with evaluation allows users access to the resources. |
| Title | An intervention to support the cultivation of phronesis (practical wisdom) in ethical decision making for doctors and other healthcare professionals to benefit patients and their communities |
| Description | The intervention is the application of fifteen virtue continua that convey the 'collective practical wisdom' including the phronesis virtue of making ethical decisions for patients and their communities. This intervention advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua. Given that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. With support from The Phronesis Foundation CIC the intervention can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby easing doctors' vulnerability in this context and benefitting patients and their communities. |
| Type | Support Tool - For Medical Intervention |
| Current Stage Of Development | Small-scale adoption |
| Year Development Stage Completed | 2021 |
| Development Status | Under active development/distribution |
| Impact | The main impact is that it supports the cultivation of phronesis in ethical decision making practices for doctors and other healthcare professionals. |
| URL | https://www.thephronesisfoundation.com |
| Title | Phronesis Cultivation in Ethical Decision Making for Medical Students, Trainees and Qualified Doctors |
| Description | This is not a clinical trial so the ISRCTN number should be N/A. Early clinical assessment and evaluation of the intervention has been completed and this Follow on Impact and Engagement project reports on the outcomes of that evaluation. The intervention is a way of cultivation phronesis (practical wisdom) associated with ethical decision making for patients and their communities. The principle source of funding has been two AHRC awards. These awards and the activities completed to meet their objectives are described below. The original 'Phronesis (practical wisdom) and the Medical Community' research award (2015-2018) contributed theory of the virtues that the medical community in the UK practice by to make good/wise/ethical decisions for patients and their communities. A research process that draws on humanities (virtue ethics) and arts (film production) helped achieve conveying that original contribution in a film and app format. The purpose of the follow-on 'Impact and Engagement' project award (2018-2019) was to assess the impact of that contribution by evaluating its application in a series of pilots. Those pilots used the output of the research in the form of a film series, app and accompanying facilitation notes in medical undergraduate, postgraduate and CPD educational programmes. The materials were combined and used as a non-prescriptive 'moral debating resource' that convey the current 'collective practical wisdom' of the medical community interviewed and observed in order to stimulate reflection on ethical decision-making. This product and intervention is a non-prescriptive ethical debating resource in the form of a seven part film box set and app that allows medical under and post graduates, 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. In that way it could be described as a safe placement resource to support the cultivation of their practical wisdom applied to making good/wise/ethical decisions for patients and their communities. |
| Type | Support Tool - For Medical Intervention |
| Current Stage Of Development | Early clinical assessment |
| Year Development Stage Completed | 2019 |
| Development Status | Under active development/distribution |
| Clinical Trial? | Yes |
| Impact | The notable impacts from this intervention are: • Enabled medical and related healthcare professionals to cultivate phronesis (practical wisdom) in a way that improves their good/wise/ethical decision making. • Medical students and trainees gained early phronesis insights related to ethical decision making from using the resources. • Some medical schools have endorsed the research by including the resources into already very packed curricula as they can see the importance of the contribution. • Wider wellbeing impact from changes in medical decision-making practices plus a strong interest in the approach and use of the resources from other sectors/ organisations that influence national and international wellbeing. These along with others during the development process are described below. The piloting of the resources began in December 2018. The resources were set up to be accessed via a specific password protected website with pilot sites given access once they had completed a licence via Intellectual Property Services which are part of the University of Birmingham Enterprise Ltd. The pilot period was initially scheduled to run until the end of June 2019 but that was extended to June 2020 as there has been a number of sites (medical schools and CPD providers) wanting to use the materials extending beyond the 12 months of the impact and engagement project. Recruitment of pilot sites commenced in December 2018: the target audience being medical schools in England and Wales, those involved in specialist education and training in particular primary care and those involved in continuing professional development. An Information Sheet to explain the pilot evaluation process was sent with the evaluation sheets. A mail shot was sent to all ethics leads across all medical schools in England and Wales, contacts made via conferences and other events with tutors, medical directors of education and others who had expressed an interest. In addition, policy groups and professional bodies e.g. General Medical Council, Health Education England, Royal College of General Practitioners (RCGP) and Royal Society of Medicine (RSM) requested that the PI runs workshops and introduction sessions. The informal networks (social capital) of the project steering group members and previous workshop attendees also produced enquiries. By May 2019 we had 72 enquiries about using the resources. By June 2019 eleven out of the 72 had signed licence agreements. A simpler licence sign up process was requested as the original arrangement did not suit IT platforms at some sites and we know from feedback that has meant some of the 72 could not sign up. Additionally, feedback at project workshops and from initial pilots indicated two other issues. Firstly, the curricula and teaching timetable at some medical schools is packed so the way the resources are introduced needs planning at least 12 months ahead of time. That has now been done with Birmingham, Warwick, Nottingham and is planned with Lancaster and others. Second, the fact that the concepts and materials are based on practice virtue ethics philosophy a humanities grounding and primer in the concepts was requested for groups that are unfamiliar with those concepts. This grounding was designed as a one-hour introductory interactive workshop at the second workshop for the project which can be adapted for UG, PG or CPD depending on the level of knowledge. A complete retake of film episode one was also made to provide some of the background to virtue ethics and an additional seventh episode was produced to convey the ethical tensions between senior management and senior medics conveyed in the narratives of research particpants. In addition talking head videos have been produced and posted on the website to provide an openly accessible and quick introduction to the research project and findings. These updates to the resources are all now in a 'beta' version of the materials along with an improved licence sign up process. These updates as part of the formative evaluation has led to further interest in the materials. For example, Birmingham Medical School doubled the lecture time for use of the resources on the Decision Module for the 2nd year undergraduate programme in 2020 and the RCGP want to start raising awareness of the resources with their UK regional Faculty Leads at an initial webinar workshop. Eleven pilots were completed before the end of June 2019 and these formed the main data source for the summative evaluation. These included workshops, panel presentations and lectures delivered directly by project team members. Each of the original three partnering medical schools ran pilots and their data is also included. The ongoing project feedback and the formative evaluation strategy was used to keep the approach and resources in tune with the needs of the users during this period by updating the resources and the way they were presented as described above. Pilot sites were also recruited via the project partners and their networks, project workshops and by the running of sessions and exhibitions at the 2018 Annual Conferences of the Royal College of General Practitioners and the 2018 Faculty of Medical Leadership and Management Conference. In addition, the projects findings have been presented at conferences and the project's own workshops and the feedback has been used to inform this evaluation. The Northamptonshire GP trainees group watched all the videos in two sessions and used the accompanying notes to prompt discussion. The pilots include the ones below and those up June 2019 provided evaluation feedback for the impact and engagement project: • British Academy of Management Conference Workshop, 05.09.18 • International Studying Leadership Conference Workshop, 17.12.18 • GP Trainees in Northants, January 2019 - July 2019 • Lancashire Teaching Hospitals, Preston Royal Hospital pilot, 29.01.19 • Intercalated students, Birmingham Medical School, 31.01.19 and 05.02.20 • Decision module, transplantation lecture, Birmingham Medical School 04.02.19 • Warwick Medical School pilot 22.02.19 • Nottingham Medical School, lecturers and tutors pilot 13.03.19 • Clinical Fellows at University Hospitals Coventry and Warwickshire 26.03.19 • Cumbria Occupational Therapists Year 2 Masters Student lecture 02.04.19 • Royal Society of Medicine (RSM) CPD event 12.06.19 • Royal College of General Practitioners (RCGP) presentation 12.09.19 and 04.02.20 |
| URL | https://www.birmingham.ac.uk/wisedecisions |
| Title | Business to platform (B2P) version of the the ethical decision making learning programme |
| Description | This product is at the conceptual stage and will be developed with a e-learning business partner. Essentially it will provide the ethical decision-making resources as part of a fully interactive learning environment for anyone to use in their own time. |
| Type Of Technology | e-Business Platform |
| Year Produced | 2022 |
| Impact | None as yet |
| URL | https://www.thephronesisfoundation.com |
| Title | Moral Debating Resource For Leadership Decision Making in Healthcare or any Sector |
| Description | This technical product is a seven part box set of films conveying the 'Collective Practical Wisdom' of the UK medical community researched combined with a Wisdom Wheel app and a set of supporting notes for their use. It offers a new way of supporting healthcare clinicians or any leaders cultivating good/wise/ethical decisions for the people they serve and their communities. The virtue continua Wisdom Wheel comes with a process for application that consists of three stages in coming to a decision. So rather than having to consider all 15 virtues in one go they can be broken down into stages. The video series shows the 15 virtues from deficiency to excess for each being applied in medical practice. What we now know from the follow impact and engagement project is that they work as a combined technical product as a way to cultivate practice wisdom in good/wise/ethical decision making. |
| Type Of Technology | Webtool/Application |
| Year Produced | 2020 |
| Impact | We researched one practice, medical practice (arguably the most trusted practice in the world) and conveyed the collective ethos (practical wisdom) of their ethical decision-making. If their ethos is what makes doctors the most trusted profession in the world then their 'collective phronesis' could be seen to represents humanity at its best. The follow on impact and engagement project has found that it is possible to cultivate and spread phronesis within the medical practice by using a seven box set filmed version and app of their ethos as a moral debating resource. This research therefore opens the door for any profession in any country to do the same. Whether that be by using this medical practice 'collective practical wisdom' product as a starting point or conveying their own as a stimulus for moral debate. If other professions also take part in inter-practice as well as intra-practice debate with a common purpose/good of bringing wider well-being for their communities and universal flourishing for people of all nations then the outlook for humanity is promising. Given the use of this main product from the research has been proven to spread and cultivate the ethos of humanity at its best within one profession we expect it will be used by many other professions to bring wider well-being nationally and internationally. If people want to use the product then there is a licence agreement to sign which can be found at the URL below. |
| URL | https://www.birmingham.ac.uk/wisedecisions |
| Title | Wisdom Wheel App - PC version |
| Description | See the previous section for a full description. |
| Type Of Technology | Webtool/Application |
| Year Produced | 2019 |
| Impact | See previous sections for the main impacts realised so far |
| URL | https://www.thephronesisfoundation.com |
| Title | Wisdom Wheel App - Smart Phone version |
| Description | See the description for this app in the previous section. It is in the early prototyping phase of design. |
| Type Of Technology | Webtool/Application |
| Year Produced | 2022 |
| Impact | None as yet given the app is currently a prototype alpha version but hopefully these can be reported on in 2024 when it is released in beta version in 2023. |
| URL | https://www.thephronesisfoundation.com |
| Company Name | The Phronesis Foundation (TPF) Community Interest Company (CIC) |
| Description | TPF is now a fully registered not for profit research spin out CIC operating as a hybrid: research and application. It provides professional education, CPD and one-to-one coaching to suit requirements and time availability. As part of the package, TPF have an app and a film series that make the learning process enjoyable and easy to access either face to face or online. Once delegates have taken part in a train the trainer programme, they will also be able to use the resources to run training for others in their organisation. TPF can also provide the research and development to produce bespoke resources for your practice whether that be in the healthcare sector or any other sector. |
| Year Established | 2021 |
| Impact | The TPF CIC is impacting on medical community's decision making across the UK with medical school and CPD educational programmes. These include University of Warwick, Birmingham and Nottingham, Health Education England, Royal College of GPs and various conference presentations. |
| Website | https://www.thephronesisfoundation.com |
| Company Name | PHRONESIS RESEARCH AND DEVELOPMENT LTD |
| Description | This company is a trading subsidiary of The Phronesis Foundation CIC and managed all the commercial side of the spin out activity until the CIC was fully registered in September 2021. A request for this company to be closed down has was sent to companies house in February 2022. |
| Year Established | 2021 |
| Impact | This company was used to contract with the RCGP so those impacts relating to that initial collaboration in 2021 are applicable here. |
| Website | https://find-and-update.company-information.service.gov.uk/company/13220245 |
| Description | 'What does Phronesis look like' workshop at Royal Society of Medicine, London |
| 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 | Workshop as part of an all day CPD event at the Royal Society of Medicince HQ in LOndon. The participants were a mix of GPs and hospital doctors who wanted to improve their ethical decision making. The feedback from the participants was that they were very impressed with the research and the resources and they wanted to use them for their own CPD events at their institutions. One GP said that the session had been the most practical and useful in the whole day and that he would be signing up to the licence agreement to start using the resources. |
| Year(s) Of Engagement Activity | 2019 |
| Description | 2018 International Studying Leadership Conference |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| 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 | 2018,2019 |
| 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 | 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 | 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 | 2018,2019 |
| URL | https://www.fmlm.ac.uk/sites/default/files/content/resources/attachments/What%20next%20for%20medical... |
| 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 | 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 | Health Education England Enhance CPD programme - Generalist Skills - Ethical Decision Making |
| 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 | Dr Mervyn Conroy was invited to present the the research, resources and CPD offering to the Enhance Generalist Skills programme lead. This led to two further programmes. First, an online 30 min taster session for the national programme leads on 21 March and second, a two hour F2F formal CPD programme in Cheltenham to be delivered in May 2023. |
| Year(s) Of Engagement Activity | 2022,2023 |
| URL | https://www.hee.nhs.uk/our-work/enhancing-generalist-skills |
| Description | Health Services Research (HSR) UK 2020 Virtual and Online Conference presentation |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Abstract: Phronesis and the Medical Community - Summary The Phronesis and the Medical Community Project is the first empirical study of wisdom development (known as phronesis) in doctors. A collaborative three year investigation led by Health Services Management Centre at the University of Birmingham and involving the three medical schools of Birmingham, Warwick and Nottingham, it has investigated the role of practical wisdom and judgement in the context of contemporary medical practice, drawing on the responses of a large number of medical students and doctors (n=131) at different stages of their careers, along with feedback from community focus groups. The project has addressed a crucial topic in medical practice - phronesis. Phronesis - understood here as practical wisdom and judgement - is a fundamental virtue in good medical practice, yet the hierarchical nature and somewhat rigid institutional structures of many modern health care organisations often leave little scope for practitioners to develop and act on this virtue. While we know that doctors must demonstrate high level skills in managing complex clinical and ethical decisions, little is known about what it means to them to develop these wise decision making skills. The project is now in a second phase with follow on funding secured to evidence impact in the design and delivery of medical education and CPD by the use of a video series and accompanying tutor notes which the project has produced. Phronesis as a concept is the executive virtue - a crucial virtue for all good decisions in leadership for medical practice or other professions. Aristotle and MacIntyre, the two most quoted virtue ethicists, argued that developing phronesis as part of practical experience, can also be part of an educational programme. In fact MacIntyre suggested that learning through moral debating resources was a way of bringing virtuous practice (for all professions) back from the abyss - an abyss that is evidenced by the number of practice scandals in e.g. acute care, maternity care, social care, banking, cricket. Given scandals seem to have rocked arguably trustworthy practices as well as many others what are we missing in the education of the professionals involved? MacIntyre's call was clear; he said what was lacking across the board are moral debating resources in professional education that allow virtuous practices to be developed. The output of this project has therefore been the production of a video series based on interview data from doctors and medical students and accompanying tutor notes. By listening to the stories doctors and medical students told of their experiences of wise and unwise medical decisions the project has created a moral debating resource for health care leadership and practice which we are now keen to pilot. Contemporary applications of virtue ethics to medical practice often emphasise how virtue ethics provides a more holistic approach to medical practice which goes beyond the formulation and dissemination of professional guidelines and codes of ethics, and which highlights the importance of role models for junior doctors learning about what medical beneficence and other virtues amount to in practice. The project used a qualitative narrative and arts based methodology: doctors interviewed described their own journeys to wise decision making, and these journeys were then analysed using 2 established analytical frameworks. What we found was that doctors used both a describable process and a deeper, more nuanced set of 15 ethical decision components to arrive at wise decisions, including the balancing of the need to negotiate and have honest/ difficult conversations with trust, emotional intelligence, resilience, and reflection. The conversion of the findings from a set of narratives to a film series production using professional actors to convey the 15 virtues in action with patients provided the arts based element. The project demonstrates how the 15 ethical decision components exist along a continuum, and vividly conveys how these virtues are perceived, developed, enabled, or inhibited in clinical contexts. For example, it brings out how the virtue of medical honesty (eg. in disclosing a diagnosis of terminal illness to a patient) can be helpfully understood as being on a continuum in terms of the amount of information provided to patients. The project also clearly demonstrates the difficulties of acting on the virtue of justice, which can require practitioners to deny beneficial procedures to certain patients. It conveys well the challenges involved in acting courageously by questioning the decisions of more senior clinicians in the hierarchical hospital environment. Phronesis was seen as including emotional intelligence, and as allowing one to 'buy time' in some circumstances to consider and reflect on one's diagnosis and on how best to proceed in a case. The findings also highlight the generational change in the profession, which now places much greater importance on considering the ethical dimensions of one's medical decisions. Implications Wise decisions don't just come about by chance. Phronesis, the process of making practically wise decisions, is a skill many of our experienced doctors demonstrated. Unpacking the process of phronesis enables nurturing of this skill at all stages of medical training, benefiting both doctors and patients. We have developed a video series of real life clinical situations with accompanying educational materials for use in undergraduate, trainee and CPD settings. The research contribution includes a set of fifteen virtues including phronesis and a video series showing a Consultant and GP enacting the virtues gleaned from the participants' stories. The stories include what the participants consider to be both wise and unwise decisions and cover the full decision range for each virtue. So it could be argued we have encapsulated the wisdom of 131 participants from the medical community in our research findings. Thus we contribute an invaluable moral debating resource for the professional education of doctors and an approach that can also be used in other professions. The videos along with tutor notes form a debating resource to enable medical school and CPD programmes to engage in debate about practical wisdom and how it can be developed in the context of health care (and potentially with other related professions for that matter e.g. nursing, social work and police). |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://hsruk.org/hsruk/events/hsr-uk-conference-2020 |
| 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 | 2019,2020 |
| URL | https://www.birmingham.ac.uk/undergraduate/courses/med/health-management-leadership-intercalated-deg... |
| 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 | Joint symposium (three speakers) on nursing ethics: Should the nursing profession walk the 'rough ground' of phronesis individually or collectively? |
| 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 | CHARACTER AND VIRTUES IN PROFESSIONAL PRACTICE, ORIEL COLLEGE, UNIVERSITY OF OXFORD, 5 - 7 January 2023 Approximately 120 delegates attended the programme. They were a mix of academics, policy makers and practitioners. Dr Mervyn Conroy presented on the topic of 'Should the nursing profession walk the 'rough ground' of phronesis individually or collectively?' The presentation sparked questions and discussion afterwards, and the delegates reported increased interest this area for nursing and other allied health professionals. |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://www.jubileecentre.ac.uk/1607/conferences |
| Description | Medical Education MMedEd/PGDip/PGCert - MD967 - What Makes a Good Teacher? - Cultivating Phronesis (Practical Wisdom) in Decision-Making |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | Dr Mervyn Conroy recorded a seminar and then facilitated a drop in session for PG medical education students in 2021 and 2022. In 2023 Dr Mervyn Conroy and Dr Aisha Malik ran a face to face interactive seminar/ tutorial. |
| Year(s) Of Engagement Activity | 2021,2022,2023 |
| URL | https://warwick.ac.uk/fac/sci/med/study/cpd/meded/b9xd/#:~:text=Course%20structure%3A,full%20Masters... |
| Description | Occupational Therapy 2nd year masters post praduate programme at Carlisle, University of Cumbria |
| 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 | The PI was invited to present the research and resources on a patient decisions module for the second year masters students of the University of Cumbria's Occupational Therapy Masters programme. The feedback was that they found the materials and the debates they stimulated highly relevant to their discipline and wished they had the workshop in the first year of their programme. |
| Year(s) Of Engagement Activity | 2019 |
| 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 | RCGP CPD Engagement Activities |
| 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 | 1st Meeting in September 2019: Introduce the RCGP CPD Manager and Lead to the research and the resources. 2nd Meeting in February 2020: Discussed an approach to raising awareness with their Faculty Leads and an endorsement application to run in parallel. A Webinar workshop with a group of their faculty leads was delivered on 14 May 2020. This was followed by a CPD taster session for the Cumbria (NW) Faculty Lead and GPs from throughout the UK took part. The main contact was the Faculty Administrator, North West England Royal College of General Practitioners, The Outset, Sankey Street, Warrington, WA1 1NN. The programme was evaluated and received excellent feedback. This led to a full proposal being submitted to the RCGP National CPD lead for the delivery of regional CPD programmes across the UK. Funding was applied for by the National CPD Lead and a series of Learning Sets will be funded and delivered by TPF CIC. |
| Year(s) Of Engagement Activity | 2019,2020,2021,2022,2023 |
| URL | https://rcgp.my.site.com/s/lt-event?id=a1U1i000001TrkfEAC&site=a0d0Y00000AeOP6QAN |
| Description | The Transplant Lecture and Tutorial for the Decision Making (DEM) Module at University of Birmingham Medical School |
| 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 | Transplant lecture plus ethical decision making drawing on the findings from the Phronesis and the Medical Community project. The lecture was for 350-400 x 2nd year medical students. Invited back each year with more time given in 2020 to the topic and then in 2021 Dr Conroy provided a ppt recorded lecture based on the HSRUK 2020 presentation. In 2022 Dr Conroy ran a face to face lecture. In 2023 the lecture was added to with one hour F2F tutorials in four separate rooms delivered by Dr Mervyn Conroy, Dr Chris Turner, Dr Richard Bosworth and Associate Professor Catherine Hale. For 2024 there has been a request to expand the tutorials to two hours. |
| Year(s) Of Engagement Activity | 2019,2020,2021,2022,2023 |
| URL | https://www.birmingham.ac.uk/undergraduate/courses/med/medicine.aspx |