BackgroundDelirium is a common severe neuropsychiatric condition secondary to physical illness, which predominantly affects older adults in hospital. Prior to this study, the UK point prevalence of delirium was unknown. We set out to ascertain the point prevalence of delirium across UK hospitals and how this relates to adverse outcomes.MethodsWe conducted a prospective observational study across 45 UK acute care hospitals. Older adults aged 65 years and older were screened and assessed for evidence of delirium on World Delirium Awareness Day (14th March 2018). We included patients admitted within the previous 48 h, excluding critical care admissions.ResultsThe point prevalence of Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5) delirium diagnosis was 14.7% (222/1507). Delirium presence was associated with higher Clinical Frailty Scale (CFS): CFS 4–6 (frail) (OR 4.80, CI 2.63–8.74), 7–9 (very frail) (OR 9.33, CI 4.79–18.17), compared to 1–3 (fit). However, higher CFS was associated with reduced delirium recognition (7–9 compared to 1–3; OR 0.16, CI 0.04–0.77). In multivariable analyses, delirium was associated with increased length of stay (+ 3.45 days, CI 1.75–5.07) and increased mortality (OR 2.43, CI 1.44–4.09) at 1 month. Screening for delirium was associated with an increased chance of recognition (OR 5.47, CI 2.67–11.21).ConclusionsDelirium is prevalent in older adults in UK hospitals but remains under-recognised. Frailty is strongly associated with the development of delirium, but delirium is less likely to be recognised in frail patients. The presence of delirium is associated with increased mortality and length of stay at one month. A national programme to increase screening has the potential to improve recognition.

Medical students can contribute significantly to the design and delivery of the undergraduate medical program above and beyond the simple delivery of peer-assisted "teaching". In particular, they are in a prime position to develop resources and conduct research and evaluation within the program. Their participation in all stages enables them to feel involved in course development and education of their peers and ultimately leads to an increase in student satisfaction.

Although students who acted as PAL tutors performed better than students who did not in final-year examinations, this difference was small and attributable to the students' background academic abilities. High-achieving students appear to be self-selecting as peer-tutors and their enhanced performance in LSOs may reflect their inherent academic abilities. Although peer-tutoring in itself did not lead to enhanced examination performance, further studies are required as many factors, such as the proximity of examinations and previous tutoring, can potentially affect the relationship between peer-tutoring experience and examination performance.

BackgroundObjective Structured Clinical Examination (OSCE) is a core component of undergraduate medical student assessment. With increased emphasis on integrated programmes, more courses include OSCEs in the traditionally ‘preclinical’ years. The acceptability and impact of such assessment methods at this stage of training is unknown.MethodsIn 2013 and 2014 University College London Medical School piloted a formative, integrated OSCE in years 1 and 2 of the undergraduate medical degree programme. This study with a sequential exploratory design aimed to explore the acceptability and impact of such an OSCE in the early years of medical school. 1280 students completed the OSCE and were invited to complete a questionnaire exploring their views of the OSCE (response rate 96.6 %). Four focus groups, each with five or six participants (22 in total) were subsequently held to further explore themes. Data was independently transcribed and coded using thematic analysis.ResultsStudents were strongly in favour of the introduction of an OSCE in addition to existing assessments. Six overarching themes were identified: application of knowledge and skills; OSCE as an experience; OSCE as a process; a learning curve; becoming a doctor; and creating an effective OSCE.ConclusionsResults strongly support the role of OSCE early in the medical course with many benefits reported. An OSCE at this stage aligns with the vision of integrated medical education which includes early patient contact and introduction of clinical and professional skills. It also fosters feelings of responsibility and professional identity amongst students.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0542-3) contains supplementary material, which is available to authorized users.

educator). Students and faculty members developed and taught the programme. It started with a compulsory introduction forum entitled 'How to best profit from your clerkships', which was followed by an elective programme of five 2-hour interactive workshops addressing the following six themes: oneto-one peer teaching; training in procedural skills; giving feedback; orienting peers in a new clinical environment; interprofessional communication, and reflective practice based on logbook recordings. The programme ended with a formative assessment against predefined criteria during a simulated teaching interaction with a 'standardised peer'. The programme evaluation was based on students' ratings on a 12-item questionnaire (global evaluation, objectives, expectations, usefulness, format, etc.) and their oral feedback at the end of the course. Evaluation of results and impact We implemented the programme in 2006-07 with 16 elective Year 4 students in a 6-year curriculum. All of them successfully reached the predetermined performance levels and impressed examiners during their interactions with standardised peers. Students expressed high levels of satisfaction, both during the oral feedback session and in the evaluation questionnaire (mean range among the tested dimensions 4.1 [standard deviation, SD 0.26] to 4.8 [SD 0.45], on a Likert scale of 1-5, 5 being the highest level). Our first experience was thus encouraging and we are currently offering the programme for a second year, during which three former students have become coaches for the new students. In conclusion, students successfully initiated an undergraduate elective programme providing tools for peer teaching in real clinical practice. Its potential impact on preparing future residents' teaching skills requires further research.