Education for Primary Care最新文献

Medical schools across England face well-recognised challenges recruiting sufficient general practice placements for their students. Given the previously planned expansion in medical school places outlined in the last Government's NHS Long Term Workforce Plan and plans to expand medical school places and train thousands more general practitioners laid out in the current Government's Fit for the Future: 10 Year Health Plan, it is essential that medical schools understand the factors influencing a practice's decision to engage with undergraduate placements. To address this, an electronic survey of general practices across England was undertaken to identify these factors with 242 responses collected. Thematic analysis of the freetext data was undertaken and found that workload and pressure on estates remain the biggest challenges to hosting medical students. Lack of support from medical schools, burdensome placement requirements and unprofessional student attitudes and behaviours were cited as a negative influence upon their decision to host. Financial renumeration was cited as both a positive and negative incentive for providing placements, suggesting that the introduction of the national funding tariff in 2022 has addressed the disparity between funding received by practices. The findings of this study add weight to the argument that addressing underfunding of medical student teaching in general practice is essential to positively impact upon placement availability. By brokering expectations between medical students and practising clinicians regarding professional behaviours and ensuring curriculum design is not unduly burdensome or restrictive, medical schools may be able to improve placement capacity within general practice.

Background: General Practitioners (GPs) play a role in mitigating health inequalities and GP training must enable the development of the relevant knowledge, skills and attitudes to meet population needs.

Methods: As part of a review of Health Inequalities (HI) education for GP registrars in Scotland, we undertook three focus groups exploring registrars' perceptions and experiences of navigating health inequalities in practice and their perception of their training for this. Reflexive thematic analysis was utilised to analyse our data, underpinned by a lens of Transformative Learning (TL) theory.

Results: TL enabled 4 key themes to emerge: 1. The current inequity of opportunity for health inequalities learning across Scotland and between practices. 2. How learning about health inequalities is conceptualised can limit opportunities for transformative learning, 3. The importance of learner-centred approaches 4. The need to consciously 'design in' HI education to GP training.

Conclusion: These focus groups have informed the development of our future health inequalities educational provision. Furthermore, they have highlighted transferable considerations for GP training, especially how GP registrars might be supported to capitalise on the transformative learning experiences encountered in training to create a 'fit for the future' GP workforce.

In modern healthcare, mentorship, medical education, and mental health support are often treated as separate domains, yet each can inform and strengthen the others. Drawing on my experiences as a junior doctor, educator, and counselling client, I explore the parallels between effective mentorship and therapeutic dialogue, and how these insights can enhance medical teaching. My early career ambition to enter neurosurgery, followed by a period of professional disappointment, led me to seek counselling, where I encountered concepts such as Transactional Analysis and the Taxonomy of Engagement. These frameworks, alongside reflective conversations, reshaped my understanding of communication, rapport-building, and learner motivation. I illustrate how strategies used in counselling - such as asking purposeful questions, recognising ego states, and fostering curiosity - can enrich the mentor-mentee and teacher-student relationship. By integrating principles from mental health practice into mentorship and medical education, we can cultivate environments that support not only clinical competence but also resilience, empathy and sustained professional fulfilment.

The Royal Australian College of General Practitioners (RACGP) administers high-stakes summative licensure examinations for unsupervised independent Australian general practice. Examination failure can have adverse consequences including psychological stress and financial implications. In-training assessments as predictors of summative or licensure exam outcome are frequently administered as early-training stage formative assessments. Assessments more proximate to the time of licensure examinations may also be of utility. The Mock-AKT, a formative assessment, was available to registrars of an Australian GP vocational training organisation 2 months prior to licensure examinations. The Mock-AKT was assessed over 12 months from 2017 to 2018 for predictive ability for two RACGP licencing written examinations: the applied knowledge test (AKT), a multiple-choice question-based examination, and key feature problem (KFP), a short answer-based examination. Repeat validation was completed in 2021. It had robust ability to predict outcomes of the two written licensure examinations, with excellent area under the receiver operating characteristic curves for both examinations (0.86 for AKT, and 0.82 for KFP). Mock-AKT scores were processed and used to provide medical educators with detailed and candidate-specific failure-risk information, informing discussions regarding registrars' progress and suitability to sit examinations. The Australian Mock-AKT programme is likely generalisable to other GP specialist training contexts.

Assessment in UK General Practice (GP) training has traditionally relied on high-stakes evaluations that may fail to capture the complexity of clinical competence or support equitable learner development. Programmatic assessment, based on the systematic collection of diverse, low-stakes data points over time, offers a more valid, reliable and learner-centred alternative. This article examines the limitations of the current system, outlines the principles and benefits of programmatic assessment, and explores challenges and implementation strategies. Drawing on international models and educational theory, we propose a shift towards an integrated portfolio-based approach that prioritises meaningful feedback, supports competency-based progression and has the potential to reduce reliance on high stakes examinations.

The metaphor of a pipeline is used for rural medical workforces: the sections involve structured contact between high school students, rural physicians and universities; university admission schemes to increase rural student representation in medicine; rural exposure during medical training; and to retain a rural medical workforce upon graduation. Social capital is the benefit people gain from social networks, from both their relationships, and the resources those relationships provide, and is associated with positive physical and mental health and wellbeing. Rural communities generally have a greater sense of community and social involvement and cohesion than their urban counterparts. Relationships tend to be closer and stronger in rural communities with shared sense of identity, norms and understanding and hence greater social capital. There is evidence that social capital impacts on educational outcomes. Social capital factors tend to be enacted in-place, where the student is undertaking their learning. This paper draws on examples from the literature of different social capital interventions that can support the rural pipeline. We suggest that the flow of a rural medical workforce can be boosted by social capital and the analogy of a rural river may be more apt, with the banks of the river representing different locations of rural social networks and distanced medical schools. The student journey is represented by movement down the river, moving side to side on the banks, being in-place in different settings at different parts of the medical programme with different social capital factors at play.

The Medical Licensing Assessment (MLA) has been introduced for all medical students obtaining a primary medical qualification in the UK from 2024/25. It tests 'the core knowledge, skills and behaviours needed to practise safely in the UK'. It does not, however, assess 'on the job' learning and performance in clinical practice. Undergraduate medical education's primary purpose is to prepare medical students for clinical practice. Preparedness for practice is enhanced by experiential learning in clinical settings. Evidence indicates that assessment drives learning and the existing MLA places little emphasis on assessment of experiential learning. This risks disincentivising and devaluing learning from complex real-world clinical encounters which are typical in primary care, the same learning enhances preparedness for practice. It is possible that there are gaps in the current focused and standardised MLA assessment strategy with potential for negative unintended consequences on learning in primary care and graduates' preparedness for practice. By addressing these gaps, there is scope to enhance the current MLA, ensuring more complete assessment and fostering graduate preparedness. We propose that, while there is potential for primary care to be negatively impacted by the MLA, it also provides the ideal setting for innovation to develop the 'missing piece' of the assessment jigsaw. We propose this could take the form of entrustable professional activities (EPAs), a relatively new assessment model that enables more meaningful assessment of prospective new doctors in real-world clinical settings. We set out challenges and opportunities associated with EPAs, particularly in undergraduate medical education in primary care.

Background: Increasing the number of UK medical graduates entering GP training is a national priority. However, GP practices' capacity to offer meaningful placements is challenging. Enrichment activities (EA) may provide an opportunity to increase capacity and exposure to primary care learning experiences.

Methods: An EA was any observational/interactive activity outside of core curricular experiences in primary care. GP practices provided options for EAs which were delivered to final year medical students in September 2023. Feedback surveys, comprising closed Likert-scale and open free-text questions, sought to determine student and provider views about the utility of EAs for learning experiences, satisfaction, and influence on career choices in GP.

Results: In total, 217 sessions (21.7 weeks) of EAs were undertaken. The most popular EA was working with GPs with an extended role. There was high satisfaction from providers and students. Of students, 77% felt welcomed by providers; 84.7% recommended EAs to others; 61.6% reported added value to their education. Most students were more likely to choose a future career in GP. Of providers, 95% reported value in enhancing student learning; 90% found preparation for EAs easy. Enabling themes for EAs were student engagement; insights into GP roles; exposure to unique clinical experiences. Barriers to EAs were organisational challenges by providers; more time for EAs; greater hands-on opportunities.

Conclusion: EAs provide opportunities to improve the variety and capacity of learning experiences in primary care with high levels of student and provider satisfaction. EAs may also promote more undergraduates to choose a career in GP.