Education for Primary Care最新文献

Background: To create a workforce fit for 21st century healthcare, the importance of integrating more primary care teaching into the medical undergraduate curriculum has been repeatedly highlighted; yet has been slow to realise.

Aim: To explore the lived experience of educators working together to integrate teaching at the primary-secondary care (PSC) interface and identify facilitators and barriers to achieving change.

Method: A constructivist research philosophy using qualitative methodology explored the experiences of educators involved in integrating general practice teaching into the undergraduate curriculum. Purposive sampling identified suitable primary, secondary care and pre-clinical educators who consented to semi-structured interviews remotely via Microsoft Teams. Transcripts were coded using qualitative data analysis software and themes generated through iterative and inductive analysis.

Results: Ten educators (5 General Practitioners, 3 Hospital Consultants, 2 Pre-Clinical) took part. Four main themes emerged: (i) The sociocultural context, (ii) Understanding the interface, (iii) Tensions at the primary/secondary care interface, (iv) Challenges in managing educational change. Although supporting the rational for change, a strong sense of loss of traditional teaching formats, lack of communication, and misunderstandings related to clinical work and differentiating between generalist and specialist roles were found.

Conclusion: This study is unique in revealing a complex educational landscape, with many interconnected factors to consider if general practice is to be better integrated into the undergraduate curriculum. Hidden medical education sociocultural themes require further exploratory study in terms of both interface working and curriculum development.

The UK General Medical Council (GMC) states in 'Good Medical Practice' that all doctors have a professional responsibility to work in collaboration and respect each other's skills and contributions to patient care. Despite this, it is widely accepted that denigration is occurring both between specialities and between primary and secondary care within the UK and internationally. Denigration of general practice/family medicine has been discussed and debated within medical education for a number of years and work carried out hoping to challenge the notion that students opting to take up training in this field are choosing to be 'just a GP.' The aim of our work was to take this further and adopt a longitudinal study to establish whether denigration has been persistent or diminished over time. GP Doctors in Training across the northern region were questioned about their experiences of denigration, with data collected through surveys over an eight-year period. Sadly, it appears the problem of inter-speciality denigration had not been abated. GP trainees continue to report experiencing negativity from their health care colleagues relating to their individual choice of career and the role of a GP more generally. The continuation of denigration towards general practice is alarming and raises concerns about the impact it may have on workforce morale. Family medicine (general practice) plays an integral role in the operation of health systems worldwide and yet recruitment of primary care clinicians has been, and continues to be, challenging. The reasons for this are complex and multifactorial but we need to challenge the notion that comments by clinicians and others is simply 'harmless banter'. Further work to deepen our understanding of the phenomenon would be beneficial and support the suggestion that we need to have a zero-tolerance attitude towards negative and derogatory comments made about any medical speciality.

Family medicine is a cornerstone of health care, yet its defining features often remain implicit in undergraduate medical training, making it difficult for students to grasp the discipline's distinctive logic and professional appeal. To address this gap, the 7C+ Compass was developed as a conceptual and practical tool to make family medicine's core functions visible and teachable. Based on existing frameworks, it brings together eight key functions: first contact, continuity, comprehensiveness, coordination, community engagement, patient-centredness, complexity, and professional practice. Together, they reflect family medicine's integrative role linking individual, community, and system perspectives. Implemented in a pilot teaching track, the Compass has been used in clinical placements, small-group seminars, and lectures. Early use suggests that it fosters reflection and provides a shared language for linking clinical experiences with conceptual understanding. The 7C+ Compass offers a simple, adaptable framework to enhance learning and teaching in family medicine and to strengthen its visibility within medical curricula. Future work will involve students in its refinement, align it with competency frameworks, and evaluate its educational impact across different contexts; it may also help students appreciate the scope and coherence of family medicine as a career path, a hypothesis that warrants further research.

Background: Improved decision-making skills and the confidence to deliver safe care have been identified as development needs of pharmacists working towards Advanced Practice in the UK. Interactive, online simulation was identified as a potential medium to promote the development of decision-making skills.

Aim: Design, deliver and evaluate novel online education to support pharmacists' clinical decision-making skills.

Setting: General Practice.

Development: A bespoke branching scenario-based e-learning module was developed: 'Pharmacy clinical decision-making: Myocardial infarction (MI)' to allow pharmacists to practice clinical decision-making skills independently in a risk-free environment.

Implementation: The module was available across Scotland to all pharmacists through NHS Education for Scotland's learning platform, Turas Learn.

Evaluation: From August 2021 to May 2022, learners' (n = 34) perceptions of their confidence and competence in clinical decision-making were investigated using pre- and post-evaluation surveys (utilising 5scale Likert-type questions). Key aspects of clinical decision-making relating to the scenarios were investigated; overall care, interpreting blood results and specific dose adjustments. All areas assessed showed a statistically significant increase in the self-reported competence and confidence of the learners after using the module (Wilcoxon, p < 0.01). Qualitative analysis indicated that the module was well received; learners expressed a desire for a wider range of clinical topics alongside more complexity and variation in the scenarios.

Background: Workplace learning in hospitals is a cornerstone of postgraduate medical education, enabling junior doctors to develop specialist expertise and generalist skills. General Practice (GP) trainees often spend significant time in hospital-based rotations to acquire broad clinical experience. However, the hospital environment poses challenges for GP trainees, who may find it disconnected from their primary care focus. The aim of this scoping review is to map out existing literature regarding strengths, issues and concerns associated with hospital rotations in GP training.

Methods: This scoping review adhered to the PRISMA-ScR guidelines. A systematic search across MEDLINE, Embase, Scopus, and APA PsycInfo identified relevant literature. Eligible studies included those addressing strengths, issues, and concerns of hospital rotations for GP trainees published since 2000 in English or Scandinavian languages.

Results and discussion: A total of 31 studies met the inclusion criteria. Most studies employed mixed-methods approaches, reflecting a focus on nuanced trainee and trainer experiences. Key findings highlighted mismatches between hospital rotation objectives and trainees' future roles, insufficient supervision, and limited integration with primary care. Structured connections between hospital and GP training environments were identified as potential strategies to enhance learning transfer and relevance. Variability in training organisation across settings underscored the need for tailored approaches aligned with healthcare system constraints.

Conclusion: This review emphasises the importance of strategic planning in hospital rotations for GP trainees to address identified challenges. By fostering supervision, collaboration, and primary care integration, hospital training can better support GP trainees' professional development and preparation for practice.

Medical schools across England face well-recognised challenges recruiting sufficient general practice placements for their students. Given the previously planned expansion in medical school places outlined in the last Government's NHS Long Term Workforce Plan and plans to expand medical school places and train thousands more general practitioners laid out in the current Government's Fit for the Future: 10 Year Health Plan, it is essential that medical schools understand the factors influencing a practice's decision to engage with undergraduate placements. To address this, an electronic survey of general practices across England was undertaken to identify these factors with 242 responses collected. Thematic analysis of the freetext data was undertaken and found that workload and pressure on estates remain the biggest challenges to hosting medical students. Lack of support from medical schools, burdensome placement requirements and unprofessional student attitudes and behaviours were cited as a negative influence upon their decision to host. Financial renumeration was cited as both a positive and negative incentive for providing placements, suggesting that the introduction of the national funding tariff in 2022 has addressed the disparity between funding received by practices. The findings of this study add weight to the argument that addressing underfunding of medical student teaching in general practice is essential to positively impact upon placement availability. By brokering expectations between medical students and practising clinicians regarding professional behaviours and ensuring curriculum design is not unduly burdensome or restrictive, medical schools may be able to improve placement capacity within general practice.

Background: General Practitioners (GPs) play a role in mitigating health inequalities and GP training must enable the development of the relevant knowledge, skills and attitudes to meet population needs.

Methods: As part of a review of Health Inequalities (HI) education for GP registrars in Scotland, we undertook three focus groups exploring registrars' perceptions and experiences of navigating health inequalities in practice and their perception of their training for this. Reflexive thematic analysis was utilised to analyse our data, underpinned by a lens of Transformative Learning (TL) theory.

Results: TL enabled 4 key themes to emerge: 1. The current inequity of opportunity for health inequalities learning across Scotland and between practices. 2. How learning about health inequalities is conceptualised can limit opportunities for transformative learning, 3. The importance of learner-centred approaches 4. The need to consciously 'design in' HI education to GP training.

Conclusion: These focus groups have informed the development of our future health inequalities educational provision. Furthermore, they have highlighted transferable considerations for GP training, especially how GP registrars might be supported to capitalise on the transformative learning experiences encountered in training to create a 'fit for the future' GP workforce.

In modern healthcare, mentorship, medical education, and mental health support are often treated as separate domains, yet each can inform and strengthen the others. Drawing on my experiences as a junior doctor, educator, and counselling client, I explore the parallels between effective mentorship and therapeutic dialogue, and how these insights can enhance medical teaching. My early career ambition to enter neurosurgery, followed by a period of professional disappointment, led me to seek counselling, where I encountered concepts such as Transactional Analysis and the Taxonomy of Engagement. These frameworks, alongside reflective conversations, reshaped my understanding of communication, rapport-building, and learner motivation. I illustrate how strategies used in counselling - such as asking purposeful questions, recognising ego states, and fostering curiosity - can enrich the mentor-mentee and teacher-student relationship. By integrating principles from mental health practice into mentorship and medical education, we can cultivate environments that support not only clinical competence but also resilience, empathy and sustained professional fulfilment.

The Royal Australian College of General Practitioners (RACGP) administers high-stakes summative licensure examinations for unsupervised independent Australian general practice. Examination failure can have adverse consequences including psychological stress and financial implications. In-training assessments as predictors of summative or licensure exam outcome are frequently administered as early-training stage formative assessments. Assessments more proximate to the time of licensure examinations may also be of utility. The Mock-AKT, a formative assessment, was available to registrars of an Australian GP vocational training organisation 2 months prior to licensure examinations. The Mock-AKT was assessed over 12 months from 2017 to 2018 for predictive ability for two RACGP licencing written examinations: the applied knowledge test (AKT), a multiple-choice question-based examination, and key feature problem (KFP), a short answer-based examination. Repeat validation was completed in 2021. It had robust ability to predict outcomes of the two written licensure examinations, with excellent area under the receiver operating characteristic curves for both examinations (0.86 for AKT, and 0.82 for KFP). Mock-AKT scores were processed and used to provide medical educators with detailed and candidate-specific failure-risk information, informing discussions regarding registrars' progress and suitability to sit examinations. The Australian Mock-AKT programme is likely generalisable to other GP specialist training contexts.