Health Educational Attainment and Research on Treatment Outcomes in Percutaneous Coronary Interventions (HEART-OP)

The Data will be used for the purpose of a research project: Health Educational Attainment and Research on Treatment Outcomes in Percutaneous Coronary Interventions (HEART-OP).

The aim of the research is to explore the potential relationship between a doctor’s academic performance during training and subsequent clinical practice and patient outcomes. Data requested from NHS England will enable the study to investigate this in cardiology, using the example of percutaneous coronary interventions, using the NICOR-NAPCI dataset.

The research has two objectives:

Objective 1: To evaluate the extent to which educational factors in doctors relate to subsequent evidence-based practice in cardiology.

Objective 2: To evaluate how educational factors, during a doctor's training, including performance in annual appraisals (Annual Review of Competence Progression – ARCP) and Royal College Membership examinations, relate to observed 30-day patient mortality following percutaneous coronary interventions in their subsequent patients.

Findings from this research will inform policy around assessment, standard setting and remediation during postgraduate cardiology medical training.

No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).

NHS England will provide the relevant records from the NICOR National Audit of Percutaneous Coronary Interventions (NAPCI) Audit to University of Dundee. The Data will:

• Contain no direct identifying data items but will contain a unique person ID (pseudonymised GMC number) which can be used to link the Data with other record level data within the UKMED Database already held by the recipient.

The Data will not be transferred to any other location.

The Data will be stored on servers at University of Dundee, Health Informatics Centre (HIC Trusted Research Environment) and on the Cloud provided by Amazon Web Services. Personnel from the University of York access NICOR and UKMED data within the University of Dundee TRE, where they will link the two datasets using pseudonymised GMC codes.

University of Dundee uses onsite back-up services.

The Data will be accessed by authorised personnel via remote access.

The Controller must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:

• Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;

• Access controls granting users the minimum level of access required are in place;

• Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;

• Multifactor authentication (MFA) is required for remote access;

• Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;

• All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

The Data will be linked at person record level with the doctor-level information derived from the UK Medical Education Database (UKMED).

Only the General Medical Council (GMC) possesses the technical capability to reidentify individual consultants, as it retains the original GMC registration numbers that correspond to the pseudonymised UKMED codes. However, the GMC is not involved in the processing of data disseminated for this research project. No request will be made to the GMC to reidentify any individuals, and no reidentification activities will be undertaken as part of this study. All data will remain pseudonymised throughout the duration of the project.

The expected outputs of the processing will be:

• A report of findings to the UKMED Research Subgroup, at the end of the project (2027)

• A report of findings to the Medical Protection Society Foundation (the funder), at the end of the project (2027)

• Submission to a peer reviewed journals, at the end of the project.

• Press release, accompanying publication of the journal article.

Presentations at appropriate conferences like Association for Medical Education in Europe (AMEE) annual conference & European society of cardiologists.

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived.

These requirements will be applied to tables and graphical outputs.

The outputs will be communicated to relevant recipients through the following dissemination channels:

• Journals

• Webinars open to researchers and clinicians' including medical educational seminars/ networks such as the NIHR incubator for clinical educational research, a forum where people can present innovative research in specific fields.

• Social media such as the Medical Protection Society (MPS) foundation website.

• Public reports

• Direct bilateral engagement with the Royal College of Physicians and the European Society of Cardiology

• Press/media engagement

The findings of this research study are expected to contribute to evidence-based decision-making for policy-makers, local decision-makers such as doctors, and patients to inform best practice to improve the care, treatment and experience of individuals undergoing a PCI procedure.

Specifically, the benefits anticipated are:

• Higher rates of evidence-based practice in cardiology-based investigations leading to:

>Reduced complication rates in patients undergoing Percutaneous Coronary based interventions in cardiology.

>Improved outcomes (including reduced mortality rates) in patients undergoing Percutaneous Coronary based interventions in cardiology.

• More doctors at risk of future sub-optimal practice receiving additional support or remediation leading to:

>Fewer doctors in cardiology being flagged as ‘outliers’ in terms of practice or patient outcomes.

>Fewer doctors in training having their career progression delayed unnecessarily due to having failed to meet educational standards that are not associated with future practice or patient outcomes.

It is hoped that the study findings will lead to these benefits by highlighting how performance in training (e.g. at Annual Review of Competency Progression (ARCP) or clinical examinations) is associated (or otherwise) with the tendency to show evidence-based practice, once in a Consultant role (for example, the use of imaging in complex Percutaneous Coronary Intervention cases). This means that those involved in postgraduate education can shape training policy around which doctors in training may be less likely to practice in this way or show less optimal patient outcomes. This gives rise to opportunities for remediation. There may other findings that also are relevant to educational policy; for example, whether those who repeatedly resit a specific number of clinical examinations should have a refractory period before further attempts.

Thus, any findings linking educational factors with patient outcomes and practice will be collaboratively discussed with stakeholder organisations, such as the Royal College of Physicians and European Society of Cardiology to inform policy in this area.

Yielded Benefits is not a requirement for new applications.