Education for Primary Care最新文献

Background: In the UK, to encourage academic careers, extended education posts (EEPs) exist, where standard three-year, general practice vocational training is extended, offering trainees dedicated time to spend in another specialty such as medical education (Med Ed). Little is known about whether this impacts positively on their subsequent careers.

Aims: To explore general practitioners' (GPs') experiences and career trajectories after undertaking Med Ed EEPs.

Method: Twenty-eight GPs who completed a Med Ed EEP between 2013 and 2021 were invited to participate. Semi-structured interviews were held virtually. Transcripts were coded with NVivo software and underwent thematic analysis using Braun and Clarke's six-phase framework to ensure a reiterative process of internal validation.

Results: Eight GPs took part. All were working as NHS GPs, alongside other roles. Four themes emerged: 'growing as an academic educator', 'research can be interesting', 'the academic environment' and 'juggling multiple roles is stressful'. Most were still teaching, involved in research and had undertaken formal Med Ed training. Role models and immersion in academic teams were influential. Significant tensions and stresses were experienced when balancing multiple roles. The absence of ongoing academic training tracks contributed to this.

Conclusion: EEPs impact positively on academic career development and the acquisition of appropriate skills. However, managing multiple roles is challenging and stressful. Short-term university contracts, difficulties obtaining flexible working and resultant lack of partnership or salaried clinical work highlight an urgent need to explore fixed academic training pathways after vocational training, if sustainable recruitment into primary care academia is to be achieved.

We present a model for delivering out-of-hours (OOH) teaching to year 3 medical students at Glasgow University. Clinical placement time in general practice for students is under unprecedented pressure, and scope to further increase placement capacity in daytime general practice is challenging. The OOH primary care setting is underutilized in Glasgow. We undertook a four-week pilot study based in two OOH centres in Glasgow. Third year medical students could sign up to attend a three-hour teaching session at an OOH site with a dedicated GP tutor. The logistical arrangements and evaluation of this pilot project are presented. Student, GP tutor, OOH staff and administration staff logistics are considered and learning opportunities for students in this setting are discussed. The pilot study received positive feedback from all stakeholders. Our project provides a model for further teaching in this environment to help mitigate placement shortage and provide additional valuable general practice clinical experience for students. The capacity for teaching in the OOH setting could be easily upscaled by either increasing the duration of the placement or utilising more out-of-hours sites for teaching.

Reflective practice is fundamental to postgraduate general practitioner (GP) training and ongoing professional development. However, real-world challenges like time constraints and professional isolation often limit meaningful engagement with this critical skill. This article proposes that large language models (LLMs), sophisticated artificial intelligence systems, may have potential for enhancing reflective practice. We present three case studies, in which we explore the ability of LLMs to generate thought-provoking questions, which could prompt GPs to consider new angles, address underlying factors, and bridge the gap between theory and practice. Our findings suggest that LLMs could help reframe experiences and foster deeper self reflection, particularly for isolated practitioners. While ethical concerns regarding privacy, over reliance, and potential biases exist, we consider the possibility of responsibly integrating LLMs into reflective practice. For trainees, AI-generated questions might complement personal reflection under guidance. For GPs working in isolation, LLMs present an opportunity to enhance reflective practice, challenging us to consider a place for this technological innovation without diminishing the human aspects essential to medical practice.

Integrated Training Posts (ITPs) were conceived in the 1990s and have recently increased in the Southwest of England. Most ITP evaluations have been small and undertaken over 13 years ago, so do not reflect the current training landscape. This qualitative study aimed to explore the views and experiences of ITPs amongst general practice trainees and educators. The location has increasing numbers of general practice trainees, International Medical Graduates (IMGs) and less-than-full-time trainees. Semi-structured interviews were undertaken with six trainees and two educators; all had experienced at least one ITP. Recordings were transcribed verbatim and coded. Thematic analysis was undertaken. Three themes were identified: 'The role: expectations versus reality', 'Relevance of ITPs to future GP role' and 'Educational Challenges'. Most trainees valued the additional clinical experiences ITPs offered, as well as being able to trial 'portfolio' working. Trainee and educator expectations varied considerably, particularly whether the role was primarily service or observational. Working across multiple settings could limit contact between educator and trainee and make it difficult to identify a struggling trainee. There is a need to clarify the roles of trainees and educators involved in ITPs and whether and how this might vary between posts. Further studies could explore whether choice of ITP influences retention of general practitioners, and whether all trainees including those working less-than-full-time or IMGs benefit from ITPs.

Background: Introducing medical students to the concept of Cultural Humility, we devised a teaching initiative for students to consider how power manifests through the use of language in clinical communication, with a focus on General Practice. Cultural Humility is a pedagogical framework, introduced by Tervalon and Murray-Garcia, to address what they consider as the limitations of the Cultural Competence model.

Approach: Our teaching initiative specifically focused on power in clinical communication, both oral consultations and written notes. The session was delivered to third-year medical students during their first 'clinical' year, where they regularly witness and are involved in clinical communication across primary and secondary care placements. Ethical approval was in place to analyse students' reflections on the session.

Evaluation: Students who attended engaged well. They evaluated the session positively as increasing their awareness of the power of clinical language in negatively stereotyping and dehumanising patients. They demonstrated Cultural Humility in their reflections of the unintentional harm of clinical language commonly used for the doctor-patient relationship. However, most striking for us, and where our learning as educators lies, was the low attendance at the session, despite our attempts to underline clinical relevance and importance for development as future doctors.

Implications: This article offers a framework for educators interested in Cultural Humility. The implications of this initiative are how (or how not) to develop and deliver training in this space. More consideration is required as educators, including around our own language, as to how to engage students to think around the complex topic of power.

Background: Workplace-Based Assessment (WPBA) forms a major component of the UK General Practitioner (GP) licensing, together with knowledge and clinical skills examination. WPBA includes Case-based Discussion, Consultation Observation Tool, Mini-Consultation Exercise, Multisource Feedback, Patient Satisfaction Questionnaire, Clinical Examination and Procedural Skills, Clinical Supervisor's Report, and Educational Supervisor Review. We aimed to investigate GP trainees' and trainers' perceptions and experiences of WPBA regarding validity and fairness.

Methods: We used a national online survey, with Likert-scaled and free-text responses, to a convenience sample of GP trainees and trainers, on perceptions and experiences of WPBA. Analysis included descriptive statistics, scale development, and regression models to investigate factors associated with attitudes towards WPBA, with thematic analysis of free text responses supported by NVivo 12.

Results: There were 2,088 responses from 1,176 trainees and 912 trainers. Both groups were generally positive towards WPBA, with trainers more positive or similar to trainees towards individual assessments. In a multivariable regression model, accounting for sex, ethnicity and country of primary medical qualification, trainees were significantly less positive (p < 0.001) while international medical graduates (IMGs) trained outside the European Economic Area (EEA) were significantly more (p < 0.001) positive towards WPBA. Qualitative analysis revealed varying concerns about validity and relevance, assessment burden, potential for bias, fairness to protected characteristics groups, gaps in assessment, and perceptions of individual assessments.

Discussion: Trainers' greater positivity towards elements of WPBA accords with their role as assessors. Despite concerns about bias, IMGs from outside the EEA were significantly more positive towards WPBA.

The drivers for medical students' decision making when considering which Student Selected Component (SSC) to undertake is poorly understood. Furthermore, it is unclear why students undertake a specific SSC allowing them to have an extended placement in GP in their final year. It is known that high quality GP placements encourage students to subsequently choose GP as their career, therefore if the decision-making process of students in this area can be better understood, then this may help inform medical school actions to encourage a greater uptake of these extended placements.Semi-structured interviews were conducted with final year medical students at a Scottish University. Students were selected to provide a mixture of those who had and had not chosen to undertake the extended placement. The data was transcribed and analysed using thematic analysis to generate themes which represented the data.This showed that career intention was a major factor driving SSC choice. Additionally, students sought peer feedback and tended to avoid specific SSCs if they felt a lack of internal motivation. Considering the choice for the extended placement, students tended, again, to choose based on career intentions, and they also based their decision on previous experiences of GP.Career intention and prior experience are key factors in student choice of SSC and whether to undertake an extended GP. In order to address the national shortage of GPs medical schools need to consider how they might influence these drivers.

Background: Educational escape games have become more common, yet their effectiveness needs to be evaluated to establish whether or not they are a constructive pedagogical tool.

Aim: This study explored students' experiences of a general practice (GP) based escape game to uncover whether it deserves a place in a medical school's curriculum.

Design and setting: A mixed methods case study within one Scottish Medical School.

Method: Data were collected during March 2020 via 32 video recordings of an Escape Room Game, combined with participant, post-game questionnaire analysis. Video footage was reviewed in an ethnographic manner and thematic analysis conducted.

Results: Fourteen team events constituting 718 minutes were analysed. From the footage, five themes with fourteen subthemes emerged. The five main themes were: teamwork, leadership, clinical thinking, numeracy, and gamification. From the student questionnaires (n = 131), it was reported that the GP escape room was predominantly an extremely positive educational experience.

Conclusion: Educational escape games appear invaluable in medical education. They can promote the growth of non-technical skills such as teamwork, leadership, and clinical thinking; all essential to working in a multidisciplinary team and enabling patient safety. Our participants struggled with numeracy in this high-pressured environment, this must be addressed to reduce potential mistakes made in the workplace. Results are supportive of educational escape games being worthy of a space within a medical school's curriculum. A GP-orientated escape room allows for early GP exposure from a different perspective, as well as equipping students with the skills to be successful in this field.