Education for Primary Care最新文献

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.

Introduction: Participation in research activities during undergraduate education can enhance health students' understanding of Primary Health Care (PHC) and encourage future practice in underserved rural areas.

Objective: To explore the perceptions of health sciences students regarding PHC after their involvement in data collection for a research project in rural communities of Amazonas, Brazil.

Methods: A qualitative study was conducted with 17 nursing and physiotherapy students who participated in data collection for the SAPPA project. Four focus groups were held, recorded, and transcribed. Thematic analysis was performed using ATLAS.ti 9®.

Results: The analysis generated one central category - Influence of the SAPPA Study on Student Training - and four subcategories: Contribution to Professional Life, Contribution of the Research, Facilitators for Data Collection, and Challenges and Barriers. Students reported that their involvement provided a deeper understanding of PHC, fostered critical reflection, and stimulated professional growth. Direct interaction with users in rural communities contributed to a shift in perspective regarding healthcare practice and the importance of humanised care. Despite logistical and infrastructural challenges, the students highlighted the value of the experience for their academic and professional development.

Conclusion: The study demonstrated that engaging students in rural PHC research strengthens their practical skills and promotes social commitment. Such initiatives can help shape professionals more prepared to work in remote and underserved contexts, highlighting the relevance of including field research in health education curricula.

In Australia's apprenticeship-style model of general practice training, experienced general practitioner supervisors oversee individual registrars' training in accredited training practices. In addition to providing formal in-practice education to registrars, supervisors have informal teaching and clinical support functions, including being called in by registrars seeking in-consultation advice/assistance. These ad hoc encounters are important learning opportunities but can be challenging to negotiate in the busy clinical environment and require registrars' assistance-seeking to be judiciously managed by supervisors. This study aimed to estimate variability between training practices in relation to registrars having recourse to supervisory in-consultation advice/assistance. The study used a cross-sectional analysis from the Registrar Clinical Encounters in Training project, an ongoing prospective cohort study of Australian registrars' in-consultation clinical and educational practise. Analyses used 2010 to 2021 data with outcome factor 'supervisor provided advice/assistance'. Inter-practice variability was estimated by intra-class correlation coefficients and median odds ratios within a Bayesian modelling framework. 4642 registrars contributed details of 1,026,330 problems/diagnoses 69,114 (6.73%; 95% confidence interval: 6.69-6.78%) involved in-consultation supervisory advice/assistance. On multivariable analysis, adjusting for confounding, the intra-class correlation coefficient for provision of supervisory advice/assistance was 0.043 (95% credible interval: 0.038-0.049), the median odds ratio was 1.523 (95% credible interval: 1.480-1.569). This analysis can be interpreted as a registrar randomly moving from one training practice to another will have a median of 52% increase in the odds of a registrar seeking (and a supervisor providing) in-consultation advice/assistance for a particular problem/diagnosis. These findings raise policy and practice questions about developing a consistent response to ad hoc supervisory encounters.

Background: Simulated Consultation Assessment (SCA) preparation is critical for GP trainees, with the traditional approach relying on trained medical actors. However, limited actor availability, scheduling constraints and high costs often restrict practice opportunities. This evaluation aimed to assess a conversational artificial intelligent (AI) system as an educational tool for GP consultation skills training, examining its acceptability, perceived educational impact and implementation considerations for training.

Methods: We conducted an educational innovation evaluation with GP trainees and educators (n = 22) following implementation of a conversational AI simulation system for SCA preparation. The evaluation employed a mixed-methods design incorporating validated educational assessment measures across four domains: clinical authenticity, educational utility, user experience and technical performance. Participants' perspectives were captured through structured questionnaires and open-ended feedback. Implementation considerations were assessed through cost-comparison analysis with traditional training methods.

Results: This educational innovation demonstrated strong acceptability among users, with particularly positive evaluations for clinical content authenticity (median 4.5, IQR 4-5) and educational value (median 4.5, IQR 4-5). Qualitative feedback revealed that the innovation successfully addressed key training needs, particularly around accessibility and practice frequency. More experienced educators (11+ years) rated the innovation significantly higher for educational utility (p < 0.05), suggesting potential for curriculum integration. The implementation analysis revealed resource advantages, with 24-84% cost reductions compared to traditional methods.

Conclusion: This conversational AI innovation offers GP educators a practical, cost-effective solution to training challenges, potentially addressing the modality mismatch between face-to-face training and video-based examinations. Implementation should focus on integration as a complementary curriculum tool, with ongoing evaluation of educational outcomes.

Over 50 Academic Clinical Fellows (ACF) undertake Integrated Academic Training in General Practice (GP) annually. A formal curriculum for this programme is in place. Underneath formal curricula lie hidden curricula, which students learn without being formally taught. Although this is well documented in undergraduate medical education, the hidden curriculum for academic trainees is relatively unexplored. We sought to discover the perceived hidden curriculum for ACFs to inform programme improvement.A questionnaire exploring experiences was sent to all 56 GP ACFs in London, Kent, Surrey, and Sussex and responses were thematically analysed. These themes informed a topic guide for a focus group held online with five (9%) participants, chosen through opportunity sampling of eligible individuals. Discussion was transcribed and thematically analysed to produce themes and subthemes.From the 18 (32%) survey responses and focus group discussion, four main themes were identified: management of time pressures, unequal valuation of clinical and academic work, personal development, and pressure and support.Overall hidden curriculum learning outcomes were mixed; the programme provided opportunity to develop personal skills, yet trainees gained a perceived belief that academic work is underappreciated, and that time management is challenging. Changes to the programme have been suggested. Whilst this exploratory study was limited to a geographic region of the UK, it is likely similar experiences are shared by all ACFs in GP. It would be useful to extend this work by studying hidden curricula of primary and secondary care ACFs across the UK.