Undergraduate Student Internship Programme

Open Science advocates for open access to research, including data that has been generated or captured through a trial. In the UK there has been a movement toward adopting open science with increasing expectation amongst funders and publishers of health and social care research that data be made available for re-use. We are currently preparing a dataset collected through the IMPPP trial so that it can be used by other researchers for secondary analysis.

Improving Medicines use in People with Polypharmacy in Primary Care – The IMPPP trial

The Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) cluster randomised trial evaluated a complex medication review intervention against usual care. The intervention included a clinical informatics tool to identify patients aged 18+, receiving ≥5 long-term medications and with potentially inappropriate prescribing. Training was provided to clinicians to support delivery of a four-stage medication review (i.e. a pharmacist case-note review, interprofessional collaborative discussion between the pharmacist and a general practitioner, a review with patient, and follow-up where clinically indicated). Alongside this an integrated process evaluation was also conducted.

With participant consent, the trial team collected different types of data, including data from electronic health records, training evaluation forms, patient participant questionnaires, semi-structured interviews with clinicians and patients and audio-recordings of medication reviews.

Student project
Following last years successful internship which focused on preparing IMPPP trial qualitative data, the focus for this 2026 placement will be the quantitative data. You will be supported by Dr Caddick and Dr McCahon to prepare a data deposit of IMPPP trial data for the University of Bristol Research Data Repository. This will include discussion of ethical considerations, how to contextualise a quantitative research dataset with useful metadata and develop guides to enable use of a secondary research dataset.

Background:

People with serious mental illnesses (SMI), such as schizophrenia or bipolar disorder, are more likely to be overweight, which increases the risk of diabetes, high blood pressure, and heart disease. Heart disease is a leading cause of the 15-20-year reduced life expectancy in people with SMI. This study aims to address that risk.

In the United Kingdom, general practices can refer anyone who is overweight to local weight loss programmes, which can help people lose weight. But people with SMI often report that it is hard to join or stay with these programmes, and the NHS usually does not provide extra support to help them take part.

In this study, we want to see if extra support can help people with SMI take part in weight loss programmes. Adults with SMI who are overweight and registered at participating general practice will be invited to join. General practices will look at their patient lists and contact people who they feel it is safe and appropriate to invite. Those who agree to take part will first meet a researcher to give some information about themselves, including their weight, mood, and mental health. This is called the baseline assessment and will help us understand how things start for each person.

After baseline, general practices will refer participants to a local tier 2 12-week weight loss programme and a link worker, an NHS staff member trained to provide practical and emotional support in the practice. The study starts with a one-off “Meet Your Mentor” session”, where the link worker helps participants enrol in the weight loss programme and answers any questions. Participants will then receive weekly 30-minute “Mentor Check-In” calls from their link worker for 12 weeks to provide encouragement and support.

The main aim of the study is to see if it is possible to run this kind of support in general practices (feasible) and whether participants and link workers find it helpful (acceptable). After 14 weeks from baseline, we will check how many people joined and stayed in the study, as well as the number of “Mentor Check-In” they attended. Participants and link workers will be invited to interviews to share their experiences. Participants will meet again with the researcher for a follow-up assessment, where we will repeat the weight, mood, and mental health measures.

This study was designed with people who have lived experience of SMI and being overweight, and with link workers, to make sure it is helpful and relevant. If it shows that link worker support helps people with SMI take part in weight loss programmes, we will plan a bigger study to see if it also helps them stick with the programme and lose weight more successfully than those referred without link worker support.

ISPA-T1D: Improving Support for Physical Activity in Type 1 Diabetes

A scoping review of community-based prevention and mitigation approaches to adverse childhood experiences

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic condition of the spine. Lower back pain is a typical symptom of axSpA, but this is also commonly seen in primary care for other reasons. As such, delay in diagnosis is common.

Our current research project aims to understand which primary care services these patients are accessing over this pre-axSpA diagnosis period. If we can understand which, of the many potential, primary care services people with axSpA are accessing, then we may be able to find ways to identify them more quickly.

In addition to identifying the services being used, we also want to determine the level of understanding of axSpA within the different types of health care professionals (HCP) in contact with these patients. Again, if we can understand this, we may be able to identify how these patients can be identified more quickly.

This research involves three separate studies to investigate this issue, and depending on the time-period of the internship, the student will have the opportunity to work on one or more of these. These studies include:

1. An online quantitative survey of Primary Care Network (PCN) managers to understand the services available for people experience lower back pain symptoms across England
2. Interviews with people with axSpA to understand which primary care services patients accessed before they received their diagnosis
3. An online quantitative survey to primary care HCPs to understand their knowledge of axSpA and in which areas training and education may be required

Shoulder pain is one of the most common musculoskeletal conditions, with the median population prevalence estimated at 16% globally. Annually approximately 3% of adults consult primary care for an episode of shoulder pain. Most people recovery quickly, but in 40-50% pain and disability persist for more than 6 months. Diagnosing the cause of the pain based on physical examination or imaging can be difficult and is contentious, leading to uncertainty in management, including treatment or referral decisions.

As part of a prospective cohort study investigating the prognosis and management of shoulder pain (PANDA-S), we invited people presenting with shoulder pain in primary care to attend a research clinic (link cohort protocol). Participants (n=152) received an examination of their shoulder by a physiotherapist and an ultrasound scan by an experienced sonographer. The assessments were conducted independently, blind to each other’s findings and conclusions.
The intern will describe the results from these two types of shoulder examination focusing on the most common causes of shoulder pain (e.g. frozen shoulder, tendinopathy, osteoarthritis, acromioclavicular conditions), evaluate the level of agreement, and explore possible reasons for disagreement.

The findings will be reported in a research paper and/or conference presentation, and will help to identify areas of uncertainty in the diagnostic classification of shoulder pain. The work will also help to identify subgroups of patients with shoulder pain in primary care where diagnostic imaging may provide different or complementary information to physical examination.

Non-surgical and non-pharmacological interventions for osteoarthritis in joints other than the knee: an Evidence and Gap Map 

The intern will join an ongoing project led by Dr Corp at Keele University, in collaboration with the international OARSI Rehabilitation Discussion Group Steering committee (chair: Prof Holden, https://oarsi.org/membership-discussion-groups/discussion-groups-rehabilitation). The project aims to develop an Evidence and Gap Map (EGM) to systematically identify and chart the evidence base and highlight critical evidence gaps in osteoarthritis (OA) rehabilitation interventions for joints other than the knee.

OA impacts multiple joints (hip, hand, foot, ankle, shoulder, elbow, spine, temporomandibular joint), however, research on rehabilitation (non-surgical, non-pharmacological) disproportionately focuses on knee OA1,2. Clinical guidelines often extrapolate knee OA evidence to other joints, e.g. hand or ankle/foot3, potentially overlooking joint-specific disease characteristics and thus compromising treatment applicability. Patient perspectives reinforce this gap: during a patient and public involvement workshop, an individual with ankle OA described feeling like the "forgotten cousin", underscoring the urgent need for joint-specific evidence.

The EGM will provide a structured, visual summary of research on rehabilitation for OA in joints other than the knee: summarising evidence across multiple dimensions including interventions, outcomes, populations, geographical contexts, and study design. This will inform future research priorities and strengthen the evidence base for OA rehabilitation across all affected joints.

The intern will contribute to the conduct of the EGM and participate in relevant team meetings, with anticipated involvement in screening and/or data extraction and critical appraisal. They will receive authorship credit for their work in any resulting publication(s). Ongoing support will be provided through regular supervisory meetings and access to in-house systematic review training resources.

References
1. Holden MA, Nicolson PJA, Thomas MJ, Corp N, Hinman RS, Bennell KL. Osteoarthritis year in review 2022: rehabilitation. Osteoarthritis Cartilage. 2023 Feb;31(2):177-186. doi: 10.1016/j.joca.2022.10.004. Epub 2022 Oct 13. PMID: 36244626.
2. Hall M, van der Esch M, Hinman RS, Peat G, de Zwart A, Quicke JG, Runhaar J, Knoop J, van der Leeden M, de Rooij M, Meulenbelt I, Vliet Vlieland T, Lems WF, Holden MA, Foster NE, Bennell KL. How does hip osteoarthritis differ from knee osteoarthritis? Osteoarthritis Cartilage. 2022 Jan;30(1):32-41. doi: 10.1016/j.joca.2021.09.010. Epub 2021 Sep 29. PMID: 34600121.
3. National Institute for Health and Care Excellence. (2022). Osteoarthritis in over 16s: Diagnosis and management (NICE guideline NG226). https://www.nice.org.uk/guidance/ng226

Pharmacists are playing increasingly clinical roles in primary care, including community pharmacy. Increasing numbers of pharmacists become independent prescribers (IP), and from 2026 all newly qualified pharmacists will register with an IP annotation. Pharmacy technicians are also gaining increasing levels of responsibility and are crucial in supporting pharmacists to deliver high quality clinical, patient-facing services.

At the Centre for Pharmacy Workforce Studies (CPWS), often in collaboration with the Centre for Pharmacy Postgraduate Education (CPPE), we undertake studies to evaluate and inform pharmacy policy and practice. These studies are often mix-methods and, besides being informed by existing evidence, commonly involve quantitative (surveys) and qualitative (interviews, focus groups) elements. We have a number of such studies currently ongoing. One example is our study PREPARE (Pharmacy Readiness for ExPAnded Roles & Enhanced care). This involves interviews with community pharmacy contractors/ owners and a census survey of pharmacists and pharmacy technicians to investigate how ready they are community pharmacies’ roles in neighbourhoods – under the 10 Year Health Plan

our studies will offer an opportunity for an intern to experience being part of a research team (CPWS), and offer excellent insights into engaging with existing evidence, informing study design, collecting and analysing data. An intern may also have the opportunity to support with our application for university ethics committee approval and possibly some secondary data analysis. We would hope that an intern could do things that add value to the overall work beyond what has been commissioned.

This internship will support analysis for the Volitional Help Sheet (VHS) project, a digital intervention designed to reduce self-harm among adolescent, by focusing on coping strategies. The project aims to understand how young people perceive, experience, and accept the mobile app version of VHS. The intern will work with existing qualitative datasets (‘Think Aloud’ interviews) to explore young people’s views on usability, acceptability, engagement, and perceived impact of the app.

Working closely with the research team, the intern will assist in organising, coding, and thematically analysing the data using established qualitative methods. They will help identify key themes relating to digital mental health support, barriers and facilitators to app use, and recommendations for refinement of the VHS. The project provides an excellent opportunity to gain hands-on experience with qualitative analysis in a real-world mental health study, contribute to ongoing research on adolescent self-harm prevention, and develop insight into the design and evaluation of digital health interventions.

The internship will suit students interested in mental health, digital innovation, or applied qualitative research. There will be 15-20 interview transcripts to analyse which will be feasible within the 4 week timeline. There will be opportunities to contribute to academic papers and/or conference presentations after the internship if the student would like to.

Understanding the diagnostic referral activity and consequences in advanced practice physiotherapists working in community interface clinics

This internship is embedded within a mixed-methods research project entitled “Understanding the diagnostic referral activity and consequences in advanced practice physiotherapists working in community interface clinics.” The project seeks to examine how physiotherapists working in advanced practice roles use diagnostic investigations—particularly MRI imaging—and to explore the clinical, professional, and patient-level consequences of these referral decisions.

Physiotherapists working in community interface and primary care settings increasingly have access to advanced diagnostic privileges. While these extended roles may improve access to care, they may also introduce additional professional pressures and uncertainty, with potential implications for referral behaviour, shared decision-making, and patient experience. The project aims to understand whether diagnostic referrals made by advanced practice physiotherapists working in community interface clinics are appropriate and clinically meaningful. The project will also explore how decisions are made and experienced by patients, and whether there are unintended consequences for both patients and clinicians, including potential iatrogenic harm.

The study uses a mixed-methods design. Quantitative components include analysis of routinely collected data on shared decision-making (using the CollaboRATE questionnaire), diagnostic referral rates, referral appropriateness, and therapeutic yield. Qualitative components involve in-depth interviews with patients and physiotherapists to explore beliefs, experiences, motivations, and perceptions related to diagnostic referral and imaging decisions.

The intern will support data analysis and synthesis across both quantitative and qualitative work packages. Activities will include data cleaning and descriptive analysis, contributing to the assessment of referral appropriateness and outcomes, assisting with qualitative analysis of interview data, and supporting the integration and write-up of findings. The project and any work will be under-pinned by realist methodology (For details see; https://www.ramesesproject.org/ ). The intern will receive regular supervision and mentorship from the project lead, providing a supportive environment to develop skills in mixed-methods research, applied health services research, and academic writing.

This internship offers a chance to examine gendered health experiences in primary care from patient and healthcare professional perspectives. Working with data collected during an NIHR Doctoral Research Fellowship, the student will lead a secondary analysis on a theme of their choosing. The dataset includes interviews with 32 people living with recurrent and chronic vulval pain (including women, non-binary people, and gender fluid people) and 25 healthcare professionals working across sexual health and primary care. Examples of possible themes could include exploring shame and stigma in health experiences, at-home diagnostics, digital health, temporal studies, and clinician-patient relationships.

This project is grounded in patient accounts, qualitative research, and feminist methodologies. The student will gain hands-on experience with analysing data, learning how researchers turn interviews into evidence that can shape clinical practice, training, and health policy. Training will be provided throughout the internship and no prior knowledge is expected.

The student will also be invited to attend (and help facilitate if of interest) meetings and interviews with patient representatives, community groups, and key stakeholders, where they will develop their communication skills and help ensure that our research generates impact. They will also have the opportunity to meet with stakeholders at Medical Herstory, a social impact organisation which supports gender health research.

Possible outputs from this study include publishing a visual summary/infographic, blog, conference poster, presentation or an academic paper, based on student interest.

The internship sits within a multidisciplinary primary care research team focused on antibiotic stewardship in the management of respiratory tract infections. The intern will support two projects: 1) a qualitative study of young people’s help-seeking for acute Respiratory Tract Infections (RTIs), and 2) the ‘SPARROW’ evaluation of diagnostic testing for Lower Respiratory Tract Infections (LTRIs) in Wales.

The young people’s study explores how individuals aged 18-24 in the UK manage acute respiratory tract infections and make decisions about seeking care, using semi-structured interviews.
The intern will familiarise themselves with relevant literature and study protocols and support early-stage qualitative analysis of anonymised interview data. This will include contributing to coding discussions and early theme refinement. The intern will also support Patient and Public Involvement and Engagement (PPIE) activities with an established young people’s panel including preparation of materials, supporting meeting facilitation and documentation of feedback.

The SPARROW study is a mixed-method evaluation generating real-world evidence on the use of C-reactive protein (CRP) point-of-care tests (POCTs) to guide antibiotic prescribing for LTRIs. The study examines how diagnostic testing is implemented and used in primary care across Wales, and develops and evaluates interventions to support appropriate POCT use and antibiotic prescribing. The intern will support intervention development activities, including involvement in co-design workshops with clinicians and patients, and contribute to analysis of workshop data using a framework approach.

Through these activities, the intern will gain experience in qualitative research, intervention development and PPIE activities, while working within a multidisciplinary team focused on antimicrobial stewardship, health behaviours and experiences of infection management.

An evidence synthesis of publicly available risk prediction tools to complement cancer screening

Cancer screening programmes aim to identify cases of cancer or pre-cancer in the general population in order to prevent future disease or to improve treatment outcomes by detecting disease at an earlier stage. Recent advances in digital health innovations have resulted in a growing number of digital tools, including smartphone and web apps, which have the potential to benefit cancer screening by providing information about cancer risks directly to patients and the public [1, 2].

The aim of the project will be to synthesise existing evidence on digital tools designed to complement cancer screening programmes, focusing on tools that can be used by patients and the public and which incorporate a risk prediction component. The review will aim to summarise: 1) methods used to develop the risk prediction tools [3, 4], 2) predictive performance of the models [3], and 3) impact of the digital tools on the effectiveness of cancer screening. Depending on the number of articles identified in preliminary literature searches the project scope may be modified by restricting to selected cancer types, settings (e.g. country), or measures of impact. It is intended that the completed review will be submitted for publication.

The intern will be involved in all stages of the review including designing and performing literature searches, article screening, data extraction, and writing. The project will provide practical experience of evidence synthesis methodology and enable the intern to learn about digital health and risk prediction in the context of cancer prevention.

Our research in the Workforce and Learning Research Group supports a portfolio of nationally-funded realist reviews focused on NHS primary care workforce and learning.

Realist reviews aim to understand how, why, for whom, and in what circumstances interventions or ways of working produce particular outcomes. This placement offers an undergraduate intern a structured introduction to realist thinking with one of our researchers, while contributing meaningfully to ongoing research.

We have a number of active research projects and experience of welcoming and supervising previous SPCR interns within our cross-disciplinary and cross-institutional team. We can tailor to individual SPCR intern interests, and the specific time-point they select for their internship. Opportunities to contribute to or extend our ongoing realist reviews include:

• workforce sustainability (working with the Workforce Voices research partnership) e.g. the evolving role of receptionists in general practice, the primary–secondary care interface in under-served areas
• relational continuity of care
• compound pressures in general practice.

Tailored Internship Activities
Activities and outcomes are customisable to intern interests, including:

• Realist Methodology: An overview of the realist approach with key readings and papers.
• Collaboration: Working with national/international research teams, stakeholders, and PPI members.
• Evidence Synthesis: Hands-on experience with screening, analysis, and developing programme theories (Context, Mechanism, Outcome, Configurations CMOCs).
• Dissemination: Creating accessible materials like visual narratives or infographics.
• Learning Outcomes
• Methodological Skills: Introductory understanding of realist and evidence synthesis methods.
• Professional Experience: Working on "live" health services research within a prestigious primary care department.
• Sector Knowledge: Insight into workforce issues in under-served areas.
• Impact: Understanding how evidence informs workforce policy and practice.
• Communication: Skills in translating complex findings for diverse audiences.

The internship will form part of the PERSPECTIVES research project which is funded by Cancer Research UK and co-led by Professor Jo Waller and Dr Laura Marlow at Queen Mary University of London. The aim of the first PERSPECTIVES study is to understand public perspectives of prostate cancer testing and generate evidence to support policy. The intern will support the study by becoming familiar with the context of prostate cancer testing and gathering relevant literature and media coverage to facilitate the research team’s understanding of the public perspective. The internship will be an opportunity to learn about how a research project is run including study design, data collection and analysis, day to day project management, teamworking and communication with stakeholders (e.g. the policy team at Cancer Research UK, public and patient representatives, academic colleagues).

The internship would be suitable for any student with an interest in social sciences, public health, health inequalities, cancer screening and/or early diagnosis. No previous experience is required although the role would suit someone who is interested in learning more about research. The student will be supervised and fully supported by a Postdoctoral Research Associate who works full time on the project, with additional input from the wider research team. The supervisor will discuss the student’s research and career interests and facilitate conversations with other colleagues in the department. They will also invite the student to attend and observe relevant project and centre meetings and seminars to give them exposure to working in an academic environment.

Artificial Intelligence (AI) is rapidly advancing and leading to promising healthcare innovation, and the NHS 10-Year Plan commits to building “the most artificial-intelligence-enabled. AI-enabled ambient scribes based on large language models are increasingly being introduced into General Practice. These technologies record and transcribe clinician-patient conversations and produce editable structured entries for electronic patient records, including histories, examination findings, plans, and codes. With GPs spending substantial time on administrative and computer focused tasks, these tools are promoted as a way to reduce documentation workload and allow greater attention to patients. However, whilst the use of AI in GPs is known about, the opinions of clinicians and patients on the use of these tools are not well-understood.   

The intern will join a project aimed at understanding attitudes towards AI-scribes in UK General Practice. The successful intern will help gather online forum data and analyse posts using qualitative research methods. Online forums hold a wealth of potentially useful information on patient and clinician views. There may also be the opportunity to disseminate results (e.g., at a national AI or clinical conference). This is a qualitative study, so knowledge (e.g., from university modules) of and interest in qualitative methods would be beneficial. Examples of previous forum analysis work in healthcare include on IVF (Muir and Hawking 2024) and asthma (De Simoni et al 2016). This project provides a great opportunity to contribute towards the emerging literature on AI-in-healthcare.

The intern will work alongside a team in the UK and Uganda on the collection and analysis of data from the ACCU-2 project. This is an “impact” project funded by FCDO. The abstract for the whole project is below. The precise role of the intern will depend on the needs of the project at the time when the intern is able to join the project. We anticipate this could include involvement in data cleaning and analysis.

Project abstract:

Maternal and perinatal mortality are still high in Uganda, with high unmet need for contraception. Although 86% of women deliver in health facilities, many high-risk women do not deliver in an appropriate hospital. Only 16% receive counselling about family planning after their delivery.

Our FCDO-funded feasibility trial of Antenatal Couples Counselling in Uganda (ACCU) showed that routine antenatal clinics could be used to screen health education films and deliver couples’ counselling about birth planning and post-partum family planning. This was associated with an increased uptake of delivery at an appropriate health facility and of post-partum family planning (PPFP).

We aim to scale this up to all 20 government primary health care facilities in Mbarara city and district (covering a population of 438,464) and in Rwamwanja refugee settlement (covering >100,000 refugees).

Starting in March 2026, our main activities for this project will be: (1) Screening our health education films on family planning in 7 health facilities in Mbarara city and district; (2) Adapting and screening these films in 3 health facilities serving >100,000 disadvantaged Congolese refugees in Rwamwanja settlement; (3) Training health workers in these health facilities on antenatal couples’ counselling and provision of PPFP; (4) Monitoring the impact of these activities on uptake of birth planning and PPFP; (5) Engaging stakeholders in the study sites and at the Ministry of Health Technical Working Group.

The impact will be sustained because health facilities can continue screening films at no cost after the project, and health workers can also continue to deliver couples’ counselling and PPFP

Background: Unintended pregnancy is a serious health concern in low-and-middle income countries (LMICs), because it increases risks of maternal and perinatal mortality. Long-acting reversible contraception (LARC) is the most effective form of contraception but its use in LMICs remains low, despite multiple interventions to increase uptake.

Study aims: To identify facilitators and barriers to LARC use in LMICs.

Methodology: We have started a systematic review of qualitative literature. We searched MEDLINE, EMBASE, CINAHL and Sociological abstracts using terms for LARCs and qualitative studies. The intern will update this search and will screened titles and abstracts to identify studies that met the inclusion criteria (qualitative studies about views/ experiences of LARCs in LMICs). The quality of the included papers will be assessed using the CASP checklist. A coding framework has already been developed and will be used to code data using Nvivo. The intern will update the existing thematic synthesis with new data from the updated search, and will format this for submission to a peer-reviewed journal for publication.

Background: Psidium guajava (guava) leaves are used in traditional medicine worldwide for diarrhoea. With diarrheal disease related mortality hitting 1.53 million in 2019 and the persistent incorrect use of antibiotics in lower-middle income countries when treating diarrhoea; research about effective and safe alternative treatments is imperative.

Objective: To assess the safety and effectiveness of guava leaf preparations in treating acute diarrhoea.

Search Methods: A systematic review has been conducted in 2023 but needs to be updated. Databases (AMED, CINAHL, COCHRANE, EMBASE, MEDLINE, PubMed, ProQuest, Google Scholar, CNKI, VIP and Wangfang Data) will be searched using terms for randomised controlled trials (RCTs), guava and acute diarrhoea.

A draft paper has been written already, but this will be updated with the updated search results, finalised and submitted for publication.
A meta-analysis will be prepared.

The intern will work alongside a team in the UK and Uganda on the analysis of data from the Opti-MaP project. This is a Global Health Group funded by NIHR. The abstract for the whole project is below. The precise role of the intern will depend on the specific interests of the intern, and the needs of the project at the time when the intern is able to join the project. We anticipate this could include involvement in data cleaning and analysis, and preparing manuscripts for publication. This is likely to involve mainly qualitative analysis.

Project abstract:

Research question: Can perinatal and maternal deaths be reduced by implementation of a customised ‘Toolbox’ of interventions to optimise implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) in LMICs?

Background: When implemented optimally, MPDSR has been shown to reduce maternal mortality by 35% and perinatal mortality by 30%. However, documented barriers to implementation are frequent:

• Lack of community involvement: under-notification of community deaths, infrequent community-level data collection & review
• Fear of blame / litigation among health care providers, deterring engagement / learning
• Poor quality data, hampering identification of modifiable factors
• Insufficient training at all levels
• Inadequate implementation of responses
• Lack of monitoring / accountability and funding for implementation
• Aims
• To develop and optimise intervention components to improve functionality of MPDSR
• To evaluate the effect of a customised intervention (optimising MDPSR) on maternal and perinatal mortality.

Specific objectives

1. To review existing tools, develop and adapt a harmonised toolbox of resources to optimise MPDSR implementation
2. To co-design a customised “intervention package” using the toolbox
3. To evaluate effectiveness and cost-effectiveness of the “customised intervention package” to reduce perinatal and maternal mortality.

Methods and timelines
Community Advisory Boards and Stakeholder Committees will be established and meet regularly to advise on all aspects of the project (WP1.1, months 1-48). Political Economic Analysis will be conducted (WP 1.2, m1-12).
Phase 1 (WP 2-6, m1-12): Co-development of a comprehensive “toolbox” of resources for adaptation to specific country contexts, including tools for:

• Reviewing, then proposing the amendment/development of laws and regulatory frameworks to facilitate an enabling regulatory environment for MPDSR and legal accountability for implementing responses at all levels (WP2)
• Improving data quality (WP3)
• Training and mentoring health workers across specific MPDSR roles (WP4)
• Improving MPDSR response-tracking and budgeting (WP5)
• Community death notification, data collection and review (WP6)
• Counselling bereaved families (WP6)

Phase 2 (WP7, m12-18): Developing customised “intervention packages”. Each country will hold stakeholder workshops to select, adapt and translate “toolbox” components to ensure they align with national policies, capacity, socio-economic context, and the proportion of deaths in health facilities and outside.

Phase 3 (WP8, m18-48): stepped-wedge cluster-randomised trial to assess effectiveness and cost-effectiveness of “customised intervention packages” in 9 districts (3 in each country, implemented at months 18, 24 and 30), with perinatal mortality as the primary outcome. To ensure that mortality data is reported reliably and consistently, we will also implement improved tools for death notification in all sites from month 12. Outcome data will be collected up to month 42.

Moral injury is a well-documented phenomenon amongst healthcare professionals, referring to the psychological distress encountered when there is an inability to do the right thing.

In 2022, a scoping review by Ong et al explored moral injury amongst medical students. The focus of this work was to look at whether, and why, this occurs within medical students, through the lens of Ring Theory of Personhood. They concluded that medical students were at risk, often due to their place in the medical hierarchy. Suggestions were made about how to support students suffering from moral injury, using debriefs, psychological support and role-modelling.

What is less clear is whether proactively educating students on how to navigate this gap between ‘gold standard’ and ‘best practice for this context’ can reduce their moral distress. We propose to conduct a scoping review to look at educational approaches or theories to address this issue. It is vital to ensure that moral injury is addressed in the formal, rather than the hidden, curriculum.