Education for Primary Care最新文献

Background: Advocacy is a recognised competency for medical graduates. Many medical students engage in advocacy, but research on this topic is limited. This study aimed to explore the views and experiences of medical student advocates.

Methods: Qualitative study using semi-structured interviews. Nine medical students from advocacy organisations were recruited by purposive sampling. Thematic analysis was used to generate codes and develop themes.

Results: There were five themes: triggers and enablers; barriers and disablers; knowledge, skills, and attributes; advocacy in the role of health professionals, and career aspirations; and teaching and assessment of advocacy. Triggers and enablers included internal drivers (e.g. experiencing injustice), and external drivers (e.g. role models). Obstacles included lack of institutional support, personal challenges, and discomfort around professionalism in advocacy. Student enhanced their knowledge of social issues and improved communication skills. Advocacy activities strongly influenced students' future plans. Most agreed that advocacy is an important topic in medical education, suggesting teaching it early in medical school via small-group tutorials and role-modelling. For assessment, a reflective approach was preferred over written exams.

Conclusion: Medical students' engagement in advocacy has complex facilitators and barriers, and the relationship between advocacy and professionalism requires clarity. Benefits of advocacy include fostering empathy and other transferable skills required of future doctors. Advocacy teaching was welcomed by students, with suggested approaches proposed. The optimal learning and assessment strategy remains uncertain, and further research is needed.

Introduction: International medical graduates (IMGs) have a higher rate of examination failure and are more likely to be referred to the regulator for professional performance issues than their UK-trained counterparts. Support for IMGs to reduce differential attainment takes many forms. A pilot study to assess the feasibility and utility of early intervention to increase the support available for IMGs entering general practice (GP) training was undertaken.

Method: IMGs entering GP training in one UK region were offered one-to-one, near-peer linguistic coaching during their first two weeks of training. A session focusing on cultural acclimatisation, local accent and dialect using mock patient consultations was delivered and evaluated.

Results: The coaching was valued by the trainees and the intervention allowed very early identification of a trainee who needed further support. It was possible to identify such trainees using a non-medical volunteer student coach.

Discussion: Use of a non-medical, near-peer coach for one-to-one linguistic support has not previously been described for IMGs. This pilot study confirms the acceptability and utility of this approach. Early identification of trainees requiring enhanced support allows targeted interventions in a time-pressured speciality training programme. Further study with a larger-scale and longer-term coaching programme, assessing trainee feedback and uptake of early supportive intervention is recommended.

Background: Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills.

Methods: An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed.

Results: Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men.

Conclusion: Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.

Context: Asylum seekers face significant and unique healthcare challenges, requiring healthcare practitioners, specifically in primary care, to be trained to care for this patient population. However, there is limited understanding of medical students' interest in and future ability to care for the population of asylum seekers in the United States.

Project aims: We aim to understand U.S. medical students' interest, experience, and knowledge in providing care for asylum seekers to assess the need for change in the ways in which medical schools introduce asylum seeker care to learners.

Description: A 23-question survey was administered to U.S. medical students at four institutions with asylum programmes affiliated with Physicians for Human Rights (PHR) from June 2020 to March 2021, querying various aspects of providing care to asylum seekers.

Outcomes: Of the approximately 2846 students who received the survey, 436 students (15%) completed it in its entirety. Most respondents desired training about caring for asylum seekers (91%). Over half (52%) rated their knowledge of asylum issues overall as 'poor' or 'none', and 73% thought their medical school's curriculum on asylum seeker health needed improvement.

Conclusions: Medical students at schools with affiliated asylum clinics desire to care for asylum seeker patients but feel unprepared to do so, highlighting an unmet need for formal asylum education in U.S. medical schools.

Medical students receive inadequate training in nutrition counselling, but the best way to teach this topic is unknown. To address this research gap, we developed a longitudinal blended programme - combining physical classroom experiences with online education - to teach nutrition counselling in a primary care clinical course. The learning experience comprised a pre-class online module to convey knowledge; a formative, ungraded standardised patient exercise on dietary modification to practise skills; and a written exam on nutrition knowledge and an Objective Structured Clinical Exam assessing nutrition counselling skills. We likened this three-part curriculum to a complete meal, with its self-paced online 'appetiser', in-class 'entrée' of clinical practice with patients, and 'dessert' of an assessment. We ascertained feasibility, discovered positive student reactions, and, via exam performance analysis, noted achievement of the learning objectives. This three-course meal model can be applied to any learning experience that teaches and assesses skills.

Background: Significant event analysis (SEA) is a concept familiar to clinicians as a means to facilitate group learning. Our academic primary care teaching team recognised that often significant educational events are not afforded the same formal evaluation and reflection. We designed a proforma for the analysis of events in our setting and scheduled regular meetings to discuss those events raised. In this paper we describe a year long trial of our novel Significant Event Analysis for Education (SEAFE).

Evaluation: The pilot was evaluated using an online questionnaire.

Discussion: Over the 12 months of the pilot 19 SEAFEs raised and discussed with a wide range of subjects covered. 78% of our team felt that the use of SEAFEs had imporved their practice as clinical academics and 89% supported the continued use of SEAFE.

Conclusion: We have demontrated that SEA can be used in an academic primary care educational setting to bring about group learning and improvement in academic practice. We are planning to continue the use of SEAFE within our team with plans to try to pilot this outside of a primary care setting soon.

Background: Medical schools may find it difficult to coordinate GP practices to support undergraduate medical education in primary care. In England, every Integrated Care System area now has a funded training hub to plan and upskill the primary care and community health workforce. We evaluated whether a training hub could help deliver undergraduate medical education, co-facilitated by patient educators. No published research has evaluated this model before.

Methods: We used before and after surveys (617 students), interviews (28) and focus groups (20 people) with undergraduate medical students, patient educators and training hub and medical school team members.

Findings: It was feasible for a training hub to develop and co-deliver a workshop with patient educators. 61% of Year 4 undergraduate students (first clinical year) took part, a high attendance rate during the COVID-19 pandemic. 80% of students said they learnt a lot about managing conditions in primary care and the community as a result. They particularly valued engaging with patient educators and seeing interprofessional working between GPs and pharmacists, which were cornerstones of the training hub approach. The hub was able to recruit and retain patient educators more effectively than the medical school alone. Patient educators said they felt valued and developed new skills.

Conclusions: Working with training hubs may be part of the solution to issues medical schools face when organising undergraduate education about primary care. This small evaluation suggests that this model could be tested further.