Education for Primary Care最新文献

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.

June 2023 saw an exceptionally high proportion of Outcome 5s (incomplete evidence) issued at the annual review of competency progression (ARCP) for GP Trainees in Yorkshire and the Humber (Y&H) Deanery. These outcomes created considerable time, administrative and financial costs for the deanery. Additionally, it was believed that receiving non-standard outcomes at ARCP would be detrimental to trainee wellbeing. All GP Trainees in Y&H Deanery who received an Outcome 5 at their ARCP in June 2023 were surveyed. They were asked to report their experience of receiving this outcome with reference to their wellbeing. The survey also sought to understand the reasons for this rise in non-standard outcomes to guide quality improvement work within the deanery. Trainee perspectives revealed through this survey have guided reforms within the deanery to the structure and content of teaching and resources for GP trainees. It is believed these findings may be of similar value to other educators. 47% of eligible trainees responded to the survey. It was significantly reported that receiving an Outcome 5 felt stressful. However, trainees also reported that the time and instruction given upon receiving Outcome 5 was adequate, and they felt well supported by their educational supervisors. Preparation for ARCP was described as a neutral activity. The most frequent causes for receiving Outcome 5 were as follows: accessing and evidencing Basic Life Support (BLS) training, misunderstanding Safeguarding Requirements, incorrectly completing Form R and portfolio evidence not being seen by assessors. Further detail on these issues is described in the report below.

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.

Purpose: Widening participation in medicine refers to the recruitment policy of encouraging those who are traditionally under-represented in medical school. Whilst research in the UK has investigated the processes around improving participation through recruitment and selection to medical schools, there is less focus around the period after medical school and how students from widening participation backgrounds fare in the workforce.

Methods: This study employed scoping review methodology to collate, map and summarise research in the field. Basic numerical analysis and thematic analysis were performed on the included studies.

Results: A total of 17 studies were included in this scoping review. The majority of included studies were perspective pieces and cohort studies. There was a paucity of studies reporting around the impact of widening participation of doctors with a disability on the workforce. Four themes emerged from the thematic analysis: (1) promoting diversity; (2) boosting recruitment and retention; (3) improving representation and balance; and (4) perpetuating inequalities.

Conclusions: This scoping review highlighted positive effects on the workforce of widening participation. Efforts should be undertaken to ensure widening participation students do not experience ongoing inequality in their subsequent careers on qualification from medical school. The research field would benefit from further study exploring the impact of disability on the medical workforce, and qualitative enquiry to better investigate the experiences of widening participation students in the workforce.

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.

Background: There is an established evidence base to support early clinical experience (ECE) within medical degree programmes. However, increasingly crowded clinical learning environments can make provision challenging. The aim of this research was to develop understanding about how ECE is provided within UK medical schools.

Methods: We conducted a cross-sectional study on ECE provision by UK medical schools using an electronic survey containing a mix of question styles. We gathered data on the stage at which ECE featured within curricula, the amount of ECE provided, the setting for ECE, the learning outcomes covered during ECE and whether such content was formally assessed. Support for survey dissemination was obtained from the UK Medical Schools Council (MSC) Education Leads Advisory Group (ELAG). Responses were collected between 10/05/23 and 11/10/23.

Findings: Of the 43 eligible UK medical schools, responses were received from 28 (65%). The provision of ECE amongst respondent medical schools was ubiquitous. The majority of ECE was provided within general practice and hospital settings, but community and voluntary sector settings were increasingly employed, as was technology enhanced ECE. A significant shift in the nature of the content addressed during ECE, with less focus on implementation of basic science was seen within learning outcomes. The extent to which ECE learning outcomes were formally assessed was variable.

Conclusion: The amount of ECE provided by UK medical schools has fallen. We encourage institutions to reflect on their provision of ECE and to consider how greater diversity of community settings and technology-enhanced learning could be harnessed.