Education for Primary Care最新文献

Within Canada, 25% of physicians are international medical graduates (IMGs) who completed medical school outside of Canada. While they may share similar cultural backgrounds with Canada's multi-cultural population, they have been trained abroad. The purpose of this study was to identify the rewards and challenges experienced by IMG family physicians when caring for patients of the same cultural background as the physician. Using a descriptive qualitative approach, we conducted in-depth, semi-structured interviews with 18 practicing, licenced IMG family physicians in Edmonton and Calgary, Alberta, Canada. The interview questions addressed the rewards and challenges of providing culturally concordant care. Audiotaped interviews were transcribed and subject to qualitative latent content analysis. The study findings revealed that the rewards of caring for patients of the same cultural background as the IMG family physician included: shared cultural values; a common language; and establishment of patient rapport and trust. The challenges associated with caring for patients of the same cultural background as the IMG physician included: concerns with patients crossing boundaries; communication challenges; and perception of appointments being longer. Understanding these dynamics can help better prepare IMGs for family practice, particularly in navigating professional boundaries, which should be emphasised during IMG training and induction into the healthcare system.

Background: Medical school curricula have seen an expansion of teaching in the community. A rural primary care setting may offer students a variety of patient interactions and opportunities to improve their clinical skills within small teams. GP recruitment remains challenging, especially in rural areas but exposure to such settings during training may positively influence career intentions. There is a lack of research into students' perceptions of their rural primary care placements. This study aimed to increase our understanding of medical students'experiences of rural primary care placements.

Methods: An Interpretative Phenomenological Approach explored students' lived experiences through semi-structured interviews with five final-year medical students.

Results: Interview transcripts were analysed to identify multiple Personal ExperientialThemes which led to the development of four higher-level Group Experiential Themes: adjusting to rural living; relationship with GP supervisor and team; autonomy; and developing as a doctor.

Discussion: Students'experiences were significantly influenced by their adjustment to the rural environment. With basic needs met students began to develop a sense of belonging which facilitated learning. Relationships with GP supervisors and team members were crucial, fostering a student's sense of autonomy and professional growth. Rural placements offered students the chance to integrate into small teams, to feel valued and assume 'almost doctor' roles, providing diverse patient consultations, and preparing them for independent practice.

Background: The Simulated Consultation Assessment (SCA) replaced the Recorded Consultation Assessment (RCA) as the summative clinical component of the Membership of the Royal College of General Practitioners (MRCGP) examination for the United Kingdom (UK) general practice licencing assessment in 2023. The SCA consists of 12 online consultations with trained role players, with candidates based in their own surgery. This study aimed to gather views of stakeholders on the new assessment before its introduction.

Methods: We conducted a cross-sectional online survey. Stakeholders completing the survey included pre-RCA and post-RCA GP trainees and educator/lay stakeholders. The survey questionnaire included Likert scaled responses and free text options. Analysis included descriptive statistics, scale development measuring positivity towards SCA, a multivariable model showing factors related to this, and qualitative assessment of free text responses.

Results: There were 3,174 responses from 1,533 pre-RCA trainees, 920 post-RCA trainees, and 721 educator/lay stakeholders. Responders overall were positive about the design of SCA in terms of setting, validity, preparation and fairness. Multivariable analysis showed that International Medical Graduates (IMGs) were significantly more positive compared to UK graduates (B 0.19, 95% confidence interval 0.12-0.25, p < 0.001) with no other differences by stakeholder group, age or ethnicity. Qualitative analysis identified four themes relating to setting requirements and contingency planning, acceptability and fairness to candidates, ability to assess consultation skills and the need for evidence for the new assessment.

Conclusion: Stakeholders, while positive overall, expressed suggestions relating to practice setting, the assessment's acceptability and fairness, its ability to assess consultation skills and the need for further evaluation.

With the need for an increase in non-medical prescribers (NMPs) in the NHS, there is a lack of designated prescribing practitioners (DPPs) in place to supervise trainee NMPs. An educational five-session course was developed using the Royal Pharmaceutical Society's (RPS) competency framework to support allied healthcare professional groups (HCPs) in fulfilling the role. The aim of this study was to evaluate the knowledge and confidence of learners after their attendance, on the competencies required to become a DPP. Pre and post training questionnaires were used after sessions, identifying pre-existing knowledge and confidence in the competency framework, alongside changes after the sessions, using Likert 1-10 scales, along with job details and previous DPP experience. This study was ethically approved. Responses (n = 80) represented all HCPs including pharmacists, nurses and paramedics. The average knowledge levels increased 4.08 after the session, from 5.09 for all HCPs to 9.17 (p< 0.0001). The average confidence levels increased 3.71 from 5.49 to 9.20 for all HCP's (p< 0.0001). Over half (64%, n = 52) stated they were very likely to become DPPs following this course. Almost all (90%, n = 72) stated that they did not require any other additional training. Additional roll outs of this educational course could help increase the number of NMPs in the NHS, aligning well with the aims and objectives of the NHS Long-term and access recovery plan. A notable increase was felt by the HCPs in their knowledge and confidence from the sessions, therefore this study shows the benefit of running such a programme.

Introduction: Burnout affects the primary care workforce and their educators. Health Education England (HEE) offered resources to Training Hubs to support their primary care educators, through identifying a burnout champion and offering appropriate educational support. This study evaluates these initiatives.

Methods: Data about the educational support was collected through observation of targeted training events and an Integrated Care System (ICS) educational day. The experience of burnout and the support options for educators was explored through a focus group and semi-structured interviews with key stakeholders.

Results: Primary care educators identified the following factors as causing or exacerbating their burnout: excessive workload, insufficient time, isolation, lack of debrief, generational differences and the COVID-19 epidemic. Multiprofessional educators expressed concern about a lack of support and protected time in their working day to attend training in contrast to their perception of the situation for GP educators. Identification of and terminology around multiprofessional educators further exacerbates this disparity. Individuals and their managers had difficulty identifying burnout. Practice managers were seen as central to preventing burnout.

Recommendations and conclusions: Recognising, identifying and supporting the range of educators in primary care is key to offering appropriate help to prevent and manage burnout. Peer networks and multiprofessional faculty groups were considered supportive to all the professionals. Practice managers, training hubs and educational approval processes have a role to play in supporting primary care educators in the constantly changing environment.

Background: Continuity of education (CoE) is a growing area of interest in health professions education, both for its impacts on learning (continuity of curriculum and continuity of supervision; CoS) and for its influence on patient care (continuity of patient care; CoPC). The COVID-19 pandemic offered an opportunity to examine discontinuity of education and the potential impacts of interruption to CoE, a knowledge gap in medical education research.

Methods: We conducted 14 semi-structured qualitative interviews involving participants from a Canadian family medicine programme. We recorded and transcribed interviews conducted on Zoom that were then analysed iteratively using reflexive thematic analysis to identify major themes.

Results: We identified three themes. Theme 1: Changed relationships: an alteration due to mitigation strategies. Theme 2: Preparedness for practice: a decrease despite mitigation strategies. Theme 3: Adaptivity in the face of change: a consequence of mitigation strategies.

Conclusion: This study suggests that there are three main implications resulting from the impacts of disruption to CoE. Faculty development and curricular design are needed to support interrupted relationships, including finding ways to help faculty and residents nurture changed relationships. Physicians in their first 5 years of practice who have experienced disruption in their training may benefit from additional support to address the negative impact on their sense of preparedness for practice. Finally, the positives learned from this study can be used to face future disruptions to CoE.

Background: Recruiting and retaining International Medical Graduates (IMGs) has been identified as a key component in addressing the ongoing workforce crisis in general practice. However, research shows IMG General Practitioners (GPs) face unique challenges compared to their UK-trained counterparts, impacting their welfare, retention in the workforce, and ability to provide patient care.

Aim: This study examined the challenges facing early-career IMG GPs, the help and support they access and want to access, and their perceptions and utilisation of the help and support available.

Design and setting: A mixed-methods study that collected primary data in an online survey and interviews between March and May 2023.

Method: Early-career IMG GPs based in South West England were invited to complete an online survey consisting of 5-point Likert-scale and free-text questions. Interviews were completed with key informants and some survey respondents. Qualitative data were analysed thematically. Data from the survey and interviews were analysed and merged using a convergent parallel design.

Results: Based on 29 survey replies and 9 interviews, four interrelated themes were identified: (i) communication and language, (ii) racism, unequal treatment, and developing coping mechanisms (iii), exclusion and being 'othered', and (iv) adapting to new ways of living and working. Although some IMG GPs access help and support, many feel this is insufficient and poorly accessible.

Conclusion: IMG GPs face interrelated and unique challenges in their personal and professional lives and do not feel adequately supported by the NHS. Addressing this disconnect will be vital to sustaining the general practice workforce.

Menorrhagia is a condition in which the prevalence varies greatly, with some studies estimating that it can impact up to 25% of women. Menorrhagia, or heavy menstrual periods, can be part of a woman's normal menstrual lifecycle, and is impacted by events such as pregnancy and the menopause, as well as other gynaecological conditions such as endometrial cancer. Menorrhagia's definition is now broadly based on the woman's subjective experience of excessive blood loss and impact on quality of life. However, research suggests that women are undereducated about menorrhagia, feel societal pressure to mask their symptoms and may turn to online resources of variable validity in the quest for information.This project sought to understand the adherence of clinicians at a Derbyshire general practice to NICE guidelines regarding history documentation, discussion and provision of resources in patients with menorrhagia from May 2024 to November 2024. Fifty patients were identified following a SystemOne search of the terms 'menorrhagia' or 'excessive and frequent menstruation', 'heavy menstrual period' and 'perimenopausal menorrhagia'.Overall, documentation according to NICE guidelines was poor, often missing the impact of menorrhagia on a woman's quality of life, and there was a lack of documentation regarding the provision of evidence-based resources for patient education. These findings likely represent growing time pressures of practitioners. To combat this, a 'Heavy Periods Passport' has been developed to be uploaded to the patient record to address this gap in the clinical record, ensure patients are provided with accurate information and to improve continuity of care.