Education for Primary Care最新文献

The healthcare needs of transgender patients are unique and not accounted for within dominant narratives of medical care. This article explores care challenges faced by two transgender individuals navigating healthcare systems and medical school curriculum in Canada. Medical education has a critical role to play in addressing the invisibility of gender and sexually diverse patients, and the inclusion of diverse patients' stories in medical education can help train emerging medical professionals to apply affirming lenses to their care practices and foster a more inclusive and supportive environment for all.

Menorrhagia is a condition in which the prevalence varies greatly, with some studies estimating that it can impact up to 25% of women. Menorrhagia, or heavy menstrual periods, can be part of a woman's normal menstrual lifecycle, and is impacted by events such as pregnancy and the menopause, as well as other gynaecological conditions such as endometrial cancer. Menorrhagia's definition is now broadly based on the woman's subjective experience of excessive blood loss and impact on quality of life. However, research suggests that women are undereducated about menorrhagia, feel societal pressure to mask their symptoms and may turn to online resources of variable validity in the quest for information.This project sought to understand the adherence of clinicians at a Derbyshire general practice to NICE guidelines regarding history documentation, discussion and provision of resources in patients with menorrhagia from May 2024 to November 2024. Fifty patients were identified following a SystemOne search of the terms 'menorrhagia' or 'excessive and frequent menstruation', 'heavy menstrual period' and 'perimenopausal menorrhagia'.Overall, documentation according to NICE guidelines was poor, often missing the impact of menorrhagia on a woman's quality of life, and there was a lack of documentation regarding the provision of evidence-based resources for patient education. These findings likely represent growing time pressures of practitioners. To combat this, a 'Heavy Periods Passport' has been developed to be uploaded to the patient record to address this gap in the clinical record, ensure patients are provided with accurate information and to improve continuity of care.

In this paper, we to share our development of feedback and supervision methods using video. During the last 32 years, we have developed methods of supervision in the consultation lab on Kalymnos, Greece, with more than 5,000 Danish and Swedish GPs attending. We describe how to supervise video of role-plays, real-life consultations and a new method, supervision of supervision. This work is significant because nobody - to our knowledge - has done this both in depth and extensively. 'Five Bullets': Development of methods of video-based feedback and supervision on Kalymnos; Examining the conversation as it were 'under the microscope' - First step: Training consultation skills using video-recorded patient roleplays - Second step: Supervision of 'real life' consultations on video - Third step: Recording the supervision process and reviewing it afterwards.

Different views exist about the training needs of new clinical educators and how they might be met. This contributes to the variably of early professional development offerings. One area of contention concerns the value of educational theory. A paper published in this journal questioned the importance of educational theory in delivering effective GP training and the authors claimed that they had been unable to find an explicit exploration of this issue. If we look to another field - teacher training - the place of educational theory has been thoroughly explored. Leading teacher educators have reported how unsuccessful the 'theory-first' approach has been in influencing teachers' practice and improving pupils' education. 'Realistic teacher education' is proposed as an alternative, which starts from student teachers' practical experiences and the needs and concerns that arise from them. This 'theory-later' approach has influenced novel forms of professional development for clinical educators, where theory is introduced if it is perceived as being relevant to the teaching and learning problems under discussion. This requires facilitators who are comfortable in working from practice to theory. Forsaking a 'theory-first' approach in foundational courses should not make educational theory disappear but prompts course designers to ask if it is better placed in subsequent professional development offerings when clinical educators have had some teaching experience.

Background: Medical trainees experience occupational stress, prompting increasing research to explore wellbeing interventions. To date, few meta-analyses have evaluated intervention effects, and none have focused on trainees in family medicine or general practice (FM/GP), specifically. Aim: To synthesise available literature on psychosocial interventions to promote wellbeing, and subsequently reduce ill-being or burnout, among FM/GP specialty trainees.

Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis were followed and online databases (Embase, Medline, PsycINFO, ProQuest, Scopus) systematically searched (no date limits) for published studies and dissertations. The methodological quality of included studies was reviewed (Mixed Methods Appraisal tool, GRADE assessment), and pre-post changes (Hedges' g) pooled using random effects modelling.

Results: Eleven independent studies, involving 182 FM/GP trainees, were included in this review. Evaluated studies varied in their design and the results were characterised by imprecision. Interventions differed in their content, delivery, and length. The data did not favour a single type of intervention, although supporting individuals to monitor their wellbeing did produce significant, positive effects.

Conclusions: There is a lack of evidence about the best ways to promote wellbeing in FM/GP trainees. Both the methodology and design of training and educational initiatives for FM/GP need careful consideration in order to progress this research.

Background: Recruiting and retaining International Medical Graduates (IMGs) has been identified as a key component in addressing the ongoing workforce crisis in general practice. However, research shows IMG General Practitioners (GPs) face unique challenges compared to their UK-trained counterparts, impacting their welfare, retention in the workforce, and ability to provide patient care.

Aim: This study examined the challenges facing early-career IMG GPs, the help and support they access and want to access, and their perceptions and utilisation of the help and support available.

Design and setting: A mixed-methods study that collected primary data in an online survey and interviews between March and May 2023.

Method: Early-career IMG GPs based in South West England were invited to complete an online survey consisting of 5-point Likert-scale and free-text questions. Interviews were completed with key informants and some survey respondents. Qualitative data were analysed thematically. Data from the survey and interviews were analysed and merged using a convergent parallel design.

Results: Based on 29 survey replies and 9 interviews, four interrelated themes were identified: (i) communication and language, (ii) racism, unequal treatment, and developing coping mechanisms (iii), exclusion and being 'othered', and (iv) adapting to new ways of living and working. Although some IMG GPs access help and support, many feel this is insufficient and poorly accessible.

Conclusion: IMG GPs face interrelated and unique challenges in their personal and professional lives and do not feel adequately supported by the NHS. Addressing this disconnect will be vital to sustaining the general practice workforce.

Introduction: Advance care planning (ACP) aims at empowering patients with chronic progressive disease to express and communicate their preferences for future care, but is not yet consistently applied in general practice. We explored GP residents' experiences with practicing ACP conversations through virtual simulation and its educational value.

Methods: Our study with Dutch GP residents in their first year of training used a hermeneutic phenomenological approach. Eleven participants were observed while engaging in virtual simulation, followed by an in-depth interview. Data was analysed in an iterative manner, starting from the first interview.

Results: Although the virtual simulation was mostly experienced as not realistic because it lacked the possibility of nuanced wording and personal adjustments, the GP residents did find it valuable to learn what topics can be addressed and how. The learning experience was primarily shaped by GP residents' prior real-life ACP experiences.

Discussion: Virtual simulation is a valuable part of a blended curriculum, facilitating residents to get started with or refresh the basic knowledge and skills of ACP. It is crucial that virtual simulation is followed by critical reflection with peers and supervising GPs and practice with actors or real patients to ensure GP residents can further develop their skills regarding ACP conversations.