Education for Primary Care最新文献

Background and objective: The 'problem-question-reasoning-solution-teaching' (PQRST) framework was designed for GP trainers to use for problem case discussion (PCD) with trainees. We aimed to describe and evaluate the utility of the PQRST framework for PCD in the GP setting.

Methods: We delivered a one-hour educational activity on the PQRST tool and evaluated its use in practice. GP trainers completed a pre-education survey (N = 165), followed by a post-education survey six weeks later (N = 30).

Results: Before the educational activity, most respondents were unfamiliar with the PQRST framework. Six weeks following the PQRST education activity, over 90% of respondents had applied the PQRST framework during PCD and planned to continue using it. GP trainers were significantly more likely to ask their trainees to present cases using a problem representation format following PQRST education (p < .001).

Discussion: The PQRST framework provided a more structured approach and greater confidence in PCD, indicating its utility in GP supervision and training.

Introduction: Differential attainment (DA) is the disparity between attainment levels of different groups of doctors. The causes are multi-factorial, and variations have been highlighted between International Medical Graduate (IMG) General Practice Registrars (GPRs) and United Kingdom Medical Graduates (UKMGs) in their performance of the UK licensing examination for general practice, the Applied Knowledge Test (AKT). Despite existing support measures, there remains a gap in understanding the effectiveness of interventions aimed at improving examination success for IMGs in the AKT.

Aim: To explore the preparation and support methods that IMG GPRs consider contributed to their AKT examination success.

Methods: A qualitative study using focus groups and Green et al.'s (2007) model of Thematic Analysis was used to generate codes, categories and themes. The verification techniques of member checking and inter-rater reliability were implemented.

Results: Four focus groups with a total of 13 IMG GPRs were undertaken. Four primary themes emerged from the thematic analysis: 'Awareness of Preparation Required', 'Assistance that Aids AKT Examination Success','Application of Knowledge Gained and Individual Preferences' and 'Approach and Individual Influences'.

Conclusions: This study highlights the perceived importance of personal motivation, early awareness, and proactive support from peers and educators for IMG GPRs to succeed in the AKT. The model of the '4As' (Approach, Awareness, Assistance, and Application) was developed to aid IMG GPRs in achieving success. Local strategic examination support, such as the KSS Curriculum and AKT Support for Training (CAST) programme can facilitate the application of this model. Recommendations include early discussions on differential attainment, the development of a comprehensive AKT program, and tailored educational interventions. The study also recommends further research across diverse training regions to refine educational strategies and ensure equitable opportunities.

Background: Specialist training in General Practice (GP) incorporates hospital and community-based training. The transition from hospital to General Practice can be a challenging experience. A negative experience of this transition has been shown to impact the trainee's desire to remain in General Practice.

Aim: The aim of this study was to explore GP Trainees' experiences of moving from hospital medicine to General Practice in Ireland.

Methods: This qualitative study involved an initial focus group with GP trainees. The results of this focus group informed the development of a topic guide for subsequent one-to-one semi-structured interviews with General Practice Trainees from thirteen General Practice Training Schemes nationally. Interviews were analysed using reflexive thematic analysis.

Results: 15 interviews were undertaken. The main themes identified were: 1) Finding your way - the trainer as a navigator 2) Running your own ship - developing autonomy and 3) Balancing the competing demands of General Practice. The evolving role of the trainer in supporting the transition was highlighted, as was the GP trainers' role in navigating clinical uncertainty and in shaping the participants' professional identities. The nuances of challenges such as time pressure and increased clinical responsibility were identified. These challenges were exacerbated by the pressure of clinical decision-making and a lack of confidence in applying this judgement in the community setting.

Conclusion: The results of this study can be used to inform the development of improved structures to support GP trainees in their transition from hospital to community-based practice.

Background: Workplace-Based Assessment (WPBA) forms part of the integrated assessment system for UK General Practice (GP) licencing. An Annual Review of Competence Progression (ARCP) panel evaluates either satisfactory progress or requirement for development of specific capabilities. We aimed to explore GP trainees' experiences of undertaking WPBA when failing to progress by receiving a 'developmental' outcome 2 or 3.

Methods: We used a qualitative design employing Systematic Grounded Theory and semi-structured interviews. A purposive sample of GP trainees was recruited, at different stages of training and with varying demographic characteristics, who had a previous ARCP developmental outcome. Interviews were recorded, transcribed verbatim and analysed, facilitated by NVivo 14.

Results: We interviewed 20 GP trainees during 2024 who received a developmental outcome between 2020 and 2023. We identified five themes: 'potential for early intervention', included personalised support and better information provision; 'perceptions of how WPBA reflected trainee performance' including perceptions of the validity and reliability of WPBA and need for fair, trustworthy and transparent processes to reduce unfair discrimination; 'communication difficulties' arose in relation to culture, language and reflection for some study participants; 'relationships with peers and educational setting' were felt to affect performance; and some participants experienced negative 'effects on wellbeing'.

Conclusion: Suggestions aimed at supporting and overcoming potential challenges to undertaking WPBA during GP training, including personalised support, reviewing fairness of assessments, addressing communication and cultural barriers, enhancing training environments, fostering positive relationships, and mitigating negative wellbeing impacts, some of which were already in place, with others requiring development.

Giving students more responsibility for patients during medical school may help prepare them for their transition to clinical practice. Student-led clinics (SLCs) could facilitate this. Within SLCs, students take the lead role in delivering patient care, with support and supervision from clinicians. A general practice SLC was established in Dundee, Scotland, with four final-year medical students and one general practitioner (GP) involved in each clinic. Our qualitative case study aimed to explore students' and educators' (GPs') experiences and perceptions of this SLC. Semi-structured interviews were conducted with 11 students and three educators, and 18 hrs of observation were conducted over six clinics. Interview transcripts and fieldnotes were integrated and thematically analysed, revealing five main themes. Overall, students' and educators' experiences and perceptions were positive. Students thrived in their lead role in patient care, gaining a sense of empowerment and developing confidence in their abilities. Both students and educators felt comfortable with students having this level of responsibility due to students' seniority and the supervision provided by educators. Teaching in the SLC involved individual discussions and group debriefs. Students developed a sense of belonging as a result of their positive relationships with peers and educators and the environment of the Student Hub. Challenges arose when the clinic ran behind schedule due to unexpectedly complex patients or lengthy individual discussions. Our findings suggest that giving students responsibility for real patients is beneficial and feasible when adequate support is provided and that it is possible for one GP to supervise multiple students successfully.

The healthcare needs of transgender patients are unique and not accounted for within dominant narratives of medical care. This article explores care challenges faced by two transgender individuals navigating healthcare systems and medical school curriculum in Canada. Medical education has a critical role to play in addressing the invisibility of gender and sexually diverse patients, and the inclusion of diverse patients' stories in medical education can help train emerging medical professionals to apply affirming lenses to their care practices and foster a more inclusive and supportive environment for all.