Education for Primary Care最新文献

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.

The use of point-of-care ultrasonography in primary care is increasing. Primary care physicians are introduced to ultrasonography at short workshops with little guidance for implementation of the technology in clinical routines and medical decision-making. This article introduces a framework for longitudinal ultrasound education tailored for office-based general practice, building on the best available evidence and established teaching principles. The framework includes three teaching seminars over three months, a curriculum of 10 ultrasound applications, an online learning platform providing educational support before, during, and after the teaching seminars and continuous support and feedback from allocated mentors. The framework aims to reduce primary care physicians' absence from the clinic, scaffold the learning process to build a solid and sustainable foundation of knowledge, and support implementation and appropriate use of the technology in the unselected patient population in primary care setting. Evaluation of the framework demonstrated high satisfaction with the educational elements among both participants and teachers.

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.

The importance of involving patients in medical education is widely accepted, but their contribution to medical curriculum design is not well documented. Patients have the potential to bring a unique perspective and more refined experience to curriculum development. This applies particularly to those with long-term conditions (LTCs) who have multiple exposures to doctors throughout their healthcare journey. The aim of this study is to explore what views patients with LTCs have on the attributes medical students require to have, in order to provide them with high-quality care. Ten patients with LTCs, encompassing both primary and secondary care over a broad set of demographics, were interviewed by telephone using a semi-structured questionnaire. The interviews were recorded using a digital voice recorder and manually transcribed verbatim onto a Microsoft Word document for thematic analysis using NVIVO software and following Braun and Clarke's six-phase framework. Five themes have emerged highlighting where the care of LTC patients could be improved: 'advocacy'; 'compassion'; 'the desire to be acknowledged as an individual'"; acknowledgement of their expertise"; and 'benefits of continuity of care'. The findings make a major contribution to undergraduate and postgraduate clinical training development. They reinforce themes in healthcare which need more emphasis in the medical curriculum, whilst simultaneously highlighting that even well-recognised concepts such as patient-centred holistic care, are not well implemented in the context of actual practice.

Background: Despite commitment across national medical education and training bodies to tackle differential attainment (DA), alongside a wealth of research into contributing factors and solutions, progression in narrowing the gap has lagged. This study explores the lived experiences of doctors facing DA, career progression barriers and their wider consequences.

Methods: Interpretative phenomenological analysis was chosen as the methodological framework. The six doctors interviewed were released from General Practice training before enrolling in a 'targeted' intervention scheme designed to support them with training completion.

Results: The cohort included four international medical graduates and two graduates from the United Kingdom. Three participants were neurodiverse. Three inter-related themes were identified. 1) 'Career insecurity' is defined as uncertainty about career prospects and attainment of career goals. At varying points along their journey navigating through progression barriers, participants frequently questioned their futures and the decision to persist in the arduous pursuit of training completion. 2) 'Psychological injury' featured prominently in the experiences of the 'targeted trainees'. Feelings of worthlessness, helplessness, low energy and mood, and 'traumatic' experiences were described. 3) 'Social injury' illustrates consequences to doctors' familial and social contexts (including relationships), as well as wider societal consequences (such as attrition).

Conclusion: Our research evidences the consequences of DA and career progression barriers. We highlight the urgent need for escalated efforts in addressing the challenges faced by different groups of doctors and narrowing the attainment gap. Recommendations for interventions are included in our study.

Interprofessional collaboration (IPC) among the health professions is recognised as a vital component of efficient health systems and comprehensive healthcare teams. Interprofessional education for collaborative practice (IPECP) is foundational for health professional students to gain an understanding of professional roles, responsibilities, and the value of other professions to patient care. Oral health professionals are highly skilled and knowledgeable experts who recognise the oral-systemic health link. However, they have been largely excluded from, and underutilised within primary healthcare settings and interprofessional teams. Given that oral health is a key indicator of overall health and wellbeing, there is a need mobilise oral health professionals within primary healthcare practice. Yet, advancements for IPECP in oral health education face significant barriers which impede the integration of the oral health professions within interprofessional teams. Collaborative approaches across health programmes to devise intentional, authentic, and transformative strategies for IPECP are needed to bridge gaps in patient care and to dismantle problematic perceptions of 'oral health' as distinct from overall health and wellbeing in contemporary healthcare practice.