Education for Primary Care最新文献

Background: Educational escape games have become more common, yet their effectiveness needs to be evaluated to establish whether or not they are a constructive pedagogical tool.

Aim: This study explored students' experiences of a general practice (GP) based escape game to uncover whether it deserves a place in a medical school's curriculum.

Design and setting: A mixed methods case study within one Scottish Medical School.

Method: Data were collected during March 2020 via 32 video recordings of an Escape Room Game, combined with participant, post-game questionnaire analysis. Video footage was reviewed in an ethnographic manner and thematic analysis conducted.

Results: Fourteen team events constituting 718 minutes were analysed. From the footage, five themes with fourteen subthemes emerged. The five main themes were: teamwork, leadership, clinical thinking, numeracy, and gamification. From the student questionnaires (n = 131), it was reported that the GP escape room was predominantly an extremely positive educational experience.

Conclusion: Educational escape games appear invaluable in medical education. They can promote the growth of non-technical skills such as teamwork, leadership, and clinical thinking; all essential to working in a multidisciplinary team and enabling patient safety. Our participants struggled with numeracy in this high-pressured environment, this must be addressed to reduce potential mistakes made in the workplace. Results are supportive of educational escape games being worthy of a space within a medical school's curriculum. A GP-orientated escape room allows for early GP exposure from a different perspective, as well as equipping students with the skills to be successful in this field.

This workshop aimed to investigate students' perspectives on physician-assisted suicide (PAS) and its potential legalisation. A two-pronged strategy was used - a goldfish bowl roleplay simulation and a facilitated group discussion. The roleplay enabled students to engage with practical and emotional challenges related to responding to a PAS request, while the discussion encouraged open dialogue on the ethical complexities of legalising PAS. Students showed nuanced changes in perspectives on PAS by actively participating in roleplay and discussions, demonstrating the potential for these approaches to promote deeper understanding.

Background: Workplace-Based Assessment (WPBA) forms a major component of the UK General Practitioner (GP) licensing, together with knowledge and clinical skills examination. WPBA includes Case-based Discussion, Consultation Observation Tool, Mini-Consultation Exercise, Multisource Feedback, Patient Satisfaction Questionnaire, Clinical Examination and Procedural Skills, Clinical Supervisor's Report, and Educational Supervisor Review. We aimed to investigate GP trainees' and trainers' perceptions and experiences of WPBA regarding validity and fairness.

Methods: We used a national online survey, with Likert-scaled and free-text responses, to a convenience sample of GP trainees and trainers, on perceptions and experiences of WPBA. Analysis included descriptive statistics, scale development, and regression models to investigate factors associated with attitudes towards WPBA, with thematic analysis of free text responses supported by NVivo 12.

Results: There were 2,088 responses from 1,176 trainees and 912 trainers. Both groups were generally positive towards WPBA, with trainers more positive or similar to trainees towards individual assessments. In a multivariable regression model, accounting for sex, ethnicity and country of primary medical qualification, trainees were significantly less positive (p < 0.001) while international medical graduates (IMGs) trained outside the European Economic Area (EEA) were significantly more (p < 0.001) positive towards WPBA. Qualitative analysis revealed varying concerns about validity and relevance, assessment burden, potential for bias, fairness to protected characteristics groups, gaps in assessment, and perceptions of individual assessments.

Discussion: Trainers' greater positivity towards elements of WPBA accords with their role as assessors. Despite concerns about bias, IMGs from outside the EEA were significantly more positive towards WPBA.

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.

We present a model for delivering out-of-hours (OOH) teaching to year 3 medical students at Glasgow University. Clinical placement time in general practice for students is under unprecedented pressure, and scope to further increase placement capacity in daytime general practice is challenging. The OOH primary care setting is underutilized in Glasgow. We undertook a four-week pilot study based in two OOH centres in Glasgow. Third year medical students could sign up to attend a three-hour teaching session at an OOH site with a dedicated GP tutor. The logistical arrangements and evaluation of this pilot project are presented. Student, GP tutor, OOH staff and administration staff logistics are considered and learning opportunities for students in this setting are discussed. The pilot study received positive feedback from all stakeholders. Our project provides a model for further teaching in this environment to help mitigate placement shortage and provide additional valuable general practice clinical experience for students. The capacity for teaching in the OOH setting could be easily upscaled by either increasing the duration of the placement or utilising more out-of-hours sites for teaching.

Reflective practice is fundamental to postgraduate general practitioner (GP) training and ongoing professional development. However, real-world challenges like time constraints and professional isolation often limit meaningful engagement with this critical skill. This article proposes that large language models (LLMs), sophisticated artificial intelligence systems, may have potential for enhancing reflective practice. We present three case studies, in which we explore the ability of LLMs to generate thought-provoking questions, which could prompt GPs to consider new angles, address underlying factors, and bridge the gap between theory and practice. Our findings suggest that LLMs could help reframe experiences and foster deeper self reflection, particularly for isolated practitioners. While ethical concerns regarding privacy, over reliance, and potential biases exist, we consider the possibility of responsibly integrating LLMs into reflective practice. For trainees, AI-generated questions might complement personal reflection under guidance. For GPs working in isolation, LLMs present an opportunity to enhance reflective practice, challenging us to consider a place for this technological innovation without diminishing the human aspects essential to medical practice.

Background: Introducing medical students to the concept of Cultural Humility, we devised a teaching initiative for students to consider how power manifests through the use of language in clinical communication, with a focus on General Practice. Cultural Humility is a pedagogical framework, introduced by Tervalon and Murray-Garcia, to address what they consider as the limitations of the Cultural Competence model.

Approach: Our teaching initiative specifically focused on power in clinical communication, both oral consultations and written notes. The session was delivered to third-year medical students during their first 'clinical' year, where they regularly witness and are involved in clinical communication across primary and secondary care placements. Ethical approval was in place to analyse students' reflections on the session.

Evaluation: Students who attended engaged well. They evaluated the session positively as increasing their awareness of the power of clinical language in negatively stereotyping and dehumanising patients. They demonstrated Cultural Humility in their reflections of the unintentional harm of clinical language commonly used for the doctor-patient relationship. However, most striking for us, and where our learning as educators lies, was the low attendance at the session, despite our attempts to underline clinical relevance and importance for development as future doctors.

Implications: This article offers a framework for educators interested in Cultural Humility. The implications of this initiative are how (or how not) to develop and deliver training in this space. More consideration is required as educators, including around our own language, as to how to engage students to think around the complex topic of power.

Background and aims: In the Northwest of England, a national allocation of funding to minimise the effects of differential attainment has been used to support experienced GP educators to act as Differential Attainment Champions (DAC) since October 2021. An evaluation of the role's impact was undertaken.

Methods: The evaluation was designed to gather the views and experiences of DACs and their trainees via online semi-structured interviews during the first 12 months following establishment of the intervention programme.

Results: Thematic framework analysis identified three main themes: DACs' adaptive approach to support trainees; barriers to fulfilling the DAC role; and the positive impact of the DAC role on training. The following aspects of the DAC role worked well: the freedom to tailor support to the individual needs of the trainees; the targeted and proactive support early on in GP core training; the support of trainees in a wide range of areas including e-portfolio advice, examination preparation, and personal help. Trainees valued one-to-one support when needed. Reported improvements included: improved examination outcomes; portfolio engagement recognised in some cases by Annual Review of Competence Progression (ARCP) panels.

Conclusions: The individualised and adaptive approach works well but it does mean it is difficult to quantify how many trainees can be supported by one DAC and their workload needs to be monitored.