Education for Primary Care最新文献

Belonging is increasingly recognised as an important component of successful medical education. It affects academic achievement, wellbeing, and professional identity formation. This article examines how this concept applies to undergraduate students on community clinical placements and postgraduate vocational general practice (GP) trainees. Additionally, we consider the broader impact of belonging beyond the learner - on patient safety and quality of care. We explore how structural, cultural and relational factors can promote or hinder a sense of belonging. The shift towards competency-based training, reductions in continuity of care, and changes in the primary care infrastructure and workforce, complicate traditional notions of belonging. This highlights the need for holistic, flexible and inclusive educational practices. Key themes that promote belonging include the importance of connection through peer networks, mentorship, continuity, an inclusive learning environment which fosters psychological safety, and learner autonomy to accommodate differing needs and interests. Forming high quality relationships strengthens all of these. We propose centring a sense of belonging in medical education through a more relational approach. This can better support the development of resilient, reflective and connected general practitioners prepared to meet the evolving needs of primary care.

What was the educational challenge?: Create a new GP teaching day based at the university hospital site that inspires medical students to perceive GP lecturers as academics with a view to following primary care as a future career.

What was the solution?: Technifying and gamifying GP teaching. Collaboration with the digital education team using new technology including virtual reality (VR) headsets and immersive projector room to embed innovative teaching practices into traditional GP teaching. Also used a gamification approach to introduce quality improvement and emphasise the importance of communication between healthcare teams.

What lessons were learned?: Students highly rated this teaching. Written feedback suggested it was valued far more than lecture-based teaching due to its immersive and interactive nature. Students strongly felt it prepared them for placement.

What are the next steps?: Further evaluation of this year's student feedback and a follow-up study of perceptions of clinical and academic general practice as career options. Working with the digital technology team to enhance the current teaching further and disseminating this work across the medical school.

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.