Education for Primary Care最新文献

Addressing differential attainment between International Medical Graduates (IMGs) and their peers who hold UK Primary Medical Qualifications remains one of the most significant challenges facing postgraduate General Practice (GP) training. Enhanced Induction programme, such as the Scottish Trainee Enhanced Programme (STEP), is one tool designed to try and facilitate transition into training and reduce this inequity. The STEP course is attended by both the trainee and their educational supervisor, and aims to lay the foundations of a successful and supportive supervisory relationship. Previous work has evaluated this programme from the perspective of the trainee. Through the use semi-structured interviews, we evaluated the impact and the benefits of the programme from the perspective of the educational supervisors, building on the literature on interventions to support inequity in medical education.

It is well-established that GP trainees do not feel confident when transitioning to independent practice. In 2019, the Nottinghamshire GP Phoenix Programme Trainee Transition Scheme (TTS) was established to improve this transition and encourage local retention of newly qualified GPs. The TTS has been evaluated by surveying a total of 344 trainees from August 2022 to August 2023 using an electronic Google Form. Two-thirds of the trainees surveyed felt the mix of TTS-led non-clinical topics and trainee-led clinical topics taught during their locality time were useful for their learning. 72% felt that the TTS would influence their decision to remain working locally after qualification. Based on these positive findings, it is proposed that the TTS should be adopted in other areas to improve both transition and retention of newly qualified GPs.

A recent evaluation paper of the London General Practitioner Trainer Course by Knight et al questions the importance of educational theory in preparing GPs to become trainers and asks 'how much educational theory do GP trainers need to know in order to train effectively?' This paper places the authors' question under consideration, arguing that before the relationship between the theory and practice of education can be considered, the nature of 'educational practice' needs examination. There then follows a discussion of the work of Della Fish which presents two conceptualisations of educational practice in the context of postgraduate medical education in order to shed light on the different inferences contrasting epistemological and ontological conceptions can have, and the implications for curricula. This discussion is illustrated by offering the reader connections to papers in the field as evidence. At the heart of the paper is a conclusion that curriculum development and enquiry need to be sensitive to epistemological and ontological positionality as well as experiences and perceptions.

Introduction: Despite moves across medical education to increase learning of generalist principles, a lack of clarity about what generalism means and how we should train doctors as 'generalists', has remained. This study explores how international, undergraduate and postgraduate, policy and educational mission documents characterise the practice and learning of generalism and how this can inform physician training.

Methods: A narrative literature review was conducted based on policy and mission documents identified through grey literature searches and a wider systematic review looking at empirical texts. Texts published between 1999 and present and related to 'generalism' were eligible for inclusion. Texts were coded and codes were reviewed and grouped into key themes.

Results: Thirty-four documents were included. Definitions vary: some described generalism as a basic skill, whilst others emphasised expertise. Factors which support learning generalism include: favourable financial outcomes; ageing populations; coordination of multidisciplinary care; demand for doctors with transferable skills; and patient expectations. Barriers to learning about generalism include: preference for specialisation; structure of undergraduate teaching and assessment; and the hidden curriculum. Solutions may include re-imagining generalists and specialists as being on a continuum as well as increasing exposure throughout medical education.

Discussion: Whilst generalism is consistently positioned as valuable, less clarity exists about how best to operationalise this in medical education. Fundamental ideological and structural changes within teaching curricula and assessment, are necessary to improve generalist learning and to promote sustainable practice. Medical education needs careful, considered planning to ensure workforce expertise is meeting population needs.

Introduction: Teaching critical literature appraisal is challenging. Providing a compelling clinical context using 'cinemeduation' stimulates interest in the topic.

Methods: After watching the first episode of the mini-series 'Dopesick', where the scope, timeline and extent of the problem of opioid abuse are clearly seen, abstracts of the period literature strongly supporting the use of Oxycontin for use in chronic pain are shown. All were published in highly ranked medical journals. A simple paper evaluation structure is suggested. It is PPICOREAD which stands for the following questions: Who Paid for the study? What was the Population studied? What was the Intervention given in the study? What was the Control group used? What was the Outcome and was it of clinical significance to you? Was the trial Registered? Was there an Educational element for you? Was there anything Applicable to your practice? What was the Duration of the trial? Is this duration sufficient to reassure you that the trial is relevant to your practice?

Results: The very poor quality and dishonest nature of the conclusions of these papers are quickly and easily uncovered in a supervised workshop. The causes for these clear discrepancies are discussed. The devastating consequences are described.

A high-performing, integrated, primary healthcare system is essential to achieve universal health coverage (UHC) goals and improve health indicators. There is enough evidence that healthcare is cost-effective with significantly better outcomes in countries where primary care is delivered through trained family physicians. The concept of "Family Practice approach" is relatively new in developing countries like Pakistan, where majority of basic healthcare is provided by doctors without a formal postgraduate training. The intention to adopt this approach in primary care has increased in recent years in an effort to attain UHC, yet implementation requires a paradigm shift with intervention at multiple levels. There is an opportunity to learn from better developed primary care models for example in UK and Australia to develop a pragmatic and collaborative approach to develop the specialty of family medicine in primary care. This calls for academic interventions at multiple levels, such as mandating family medicine inclusion in undergraduate medical curricula, and ensuring quality of postgraduate training by investment in developing primary care sites for training, curricula, assessment, and quality assurance structures. Encouraging medical students and general practitioners to pursue a post graduate qualification in family medicine would also require promoting family medicine as a worthwhile career and developing a higher esteem for qualified family physicians than the conventional GPs in public and private sector healthcare institutions. These interventions would help evolution of locally grounded solutions to improve the quality of primary care, hence the health outcomes of the larger population of Pakistan.