Education for Primary Care最新文献

Introduction: Advance care planning (ACP) aims at empowering patients with chronic progressive disease to express and communicate their preferences for future care, but is not yet consistently applied in general practice. We explored GP residents' experiences with practicing ACP conversations through virtual simulation and its educational value.

Methods: Our study with Dutch GP residents in their first year of training used a hermeneutic phenomenological approach. Eleven participants were observed while engaging in virtual simulation, followed by an in-depth interview. Data was analysed in an iterative manner, starting from the first interview.

Results: Although the virtual simulation was mostly experienced as not realistic because it lacked the possibility of nuanced wording and personal adjustments, the GP residents did find it valuable to learn what topics can be addressed and how. The learning experience was primarily shaped by GP residents' prior real-life ACP experiences.

Discussion: Virtual simulation is a valuable part of a blended curriculum, facilitating residents to get started with or refresh the basic knowledge and skills of ACP. It is crucial that virtual simulation is followed by critical reflection with peers and supervising GPs and practice with actors or real patients to ensure GP residents can further develop their skills regarding ACP conversations.

A significant proportion of primary care consultations now happen remotely. Although the vast majority occur safely, a recent study highlighted areas of risk which may be compounded by the limited training many GPs have received in remote consulting. To provide safe remote services, consideration needs to be given to adapting practice workflow to optimise remote care. Patients less suitable for remote consulting, either due to disease, extremes of age, disability or for social reasons should be identified and prioritised for face-to-face encounters. Training supports both the development of individual communication skills for remote care, and effective team working. Practice-based group learning events can be used to share experiences, identify resources, and consider the risks in remote care and how they can be mitigated. The paper presents some fictionalised cases, illustrating where patients came to harm, as a result of a remote consultation, and where harm was averted due to actions taken by practice teams. These can be used to support critical thinking and discussion within practice development meetings and tutorials with trainee GPs and other practice staff. Using the paper as a basis for reflection, teaching and action can facilitate the delivery of safer remote care.

Introduction: Lack of diversity in academic staff is a national problem. At an interview for academic GP positions at our institution, there were no applicants of ethnic minority background. This does not represent our undergraduate GP teacher workforce.

Methods: To understand reasons behind the lack of applicant diversity, we held two focus groups of GP teachers at our institution's annual GP teaching fora. These were recorded, transcribed and thematically analysed.

Results: Six key themes emerged. The major theme attributed the barriers to applying for an academic GP post to individual, institutional and cultural factors. Individual factors included a concern of being under-qualified, out of comfort-zone as well as a lack of awareness of the role. Institutional factors noted insufficient ethnic minority academic role models and inaccessible advertising. Cultural factors illustrate increased challenge, disproportionate stress and paucity of contacts. Our participants discussed their recommendations for change and reflected on their positive experiences.

Discussion: Our research highlights the interplay of factors affecting applicant diversity in academic GP posts. Intersectional theory helps explain the disadvantage, and role modelling is a mechanism to break free. Change is achievable. Interventions can be targeted at both individuals and institutions, to provide momentum for cultural rehabilitation.

General practitioners (GPs) are role models with the potential to influence the career choice of medical students. Post-Covid-19, the clinical learning environment in general practice has employed new ways of working, including a greater proportion of telephone consultations. This study aimed to identify teaching solutions and strategies utilised by GP supervisors to create positive learning opportunities for final-year medical students at Brighton and Sussex Medical School (BSMS) during the academic year 2021-22. The data arose from a medical student evaluation survey, with applied thematic analysis used to identify emerging themes. The overarching theme was the use of 'supervised independence' to facilitate learning. Supervised independence involved giving learners responsibility alongside practical support which included integration into the general practice team. Five main types of learning opportunity were identified, all of which are deliverable in general practice placements more widely. The skill of facilitating supervised independence is a key attribute of an inspirational GP supervisor, which should be promoted among prospective teachers during preparation for teaching.

June 2023 saw an exceptionally high proportion of Outcome 5s (incomplete evidence) issued at the annual review of competency progression (ARCP) for GP Trainees in Yorkshire and the Humber (Y&H) Deanery. These outcomes created considerable time, administrative and financial costs for the deanery. Additionally, it was believed that receiving non-standard outcomes at ARCP would be detrimental to trainee wellbeing. All GP Trainees in Y&H Deanery who received an Outcome 5 at their ARCP in June 2023 were surveyed. They were asked to report their experience of receiving this outcome with reference to their wellbeing. The survey also sought to understand the reasons for this rise in non-standard outcomes to guide quality improvement work within the deanery. Trainee perspectives revealed through this survey have guided reforms within the deanery to the structure and content of teaching and resources for GP trainees. It is believed these findings may be of similar value to other educators. 47% of eligible trainees responded to the survey. It was significantly reported that receiving an Outcome 5 felt stressful. However, trainees also reported that the time and instruction given upon receiving Outcome 5 was adequate, and they felt well supported by their educational supervisors. Preparation for ARCP was described as a neutral activity. The most frequent causes for receiving Outcome 5 were as follows: accessing and evidencing Basic Life Support (BLS) training, misunderstanding Safeguarding Requirements, incorrectly completing Form R and portfolio evidence not being seen by assessors. Further detail on these issues is described in the report below.

Background: It is common practice for senior medical students in UK General Practice to enter details of their consultations into the electronic patient record (EPR). There is evidence that students benefit educationally from writing in patient records through learning how to make good clinical entries and enhancing their clinical reasoning. In England, since 31 October 2023, patients are given full access to their EPR, including free text notes on their consultations. Despite the importance of high-quality consultation notes, guidance on writing in the patient record is rarely included in medical curricula.

Approach: With patient and public involvement, the UKCCC (UK Council for Clinical Communication in Undergraduate Medical Education) developed a guide for students on writing in patients' General Practice (GP) notes and disseminated it to all UK medical schools from August to October 2023.

Results: The utility of the guide was evaluated via student and GP tutor surveys. Students and clinical teachers valued the guidance on content, structure, and clarity of consultation notes. A lack of awareness of the guide and suboptimal access and formatting on mobile devices were raised as areas for improvement. Other survey responses, which will inform the development of the next version, suggested adding links to learning resources.

Background: Recorded consultations are a useful tool for developing consultation skills for general practice speciality trainees (GPSTs). Historical barriers to utility include a lack of recording equipment and trainee discomfort. Widespread use of online communication platforms during the pandemic led to the introduction of the Recorded Consultation Assessment (RCA), prompting an exploration of its impact on GPSTs' attitudes and acceptability of using recorded consultations for feedback.

Aim: This sequential explanatory mixed methods study explored attitudes of military GPSTs towards using recorded consultations for feedback to develop consultation skills, and identify factors influencing GPST attitudes.

Methods: Participants of this study completed a questionnaire, followed by a representative sample focus group. Descriptive statistics were used to analyse quantitative data, reflexive thematic analysis was employed for qualitative data. Triangulation was conducted using a meta-matrix.

Results: Results indicated agreement among respondents on the usefulness of recorded consultations for developing consultation skills, particularly communication skills. Perceived trainer attitudes significantly influence the GPST utility of this tool. The RCA positively impacted attitudes, providing familiarity, free access to easy-to-use online recording platforms, simplified consenting procedures, secure data storage, and improved feedback quality from trainers.

Conclusion: Pre-pandemic studies cited equipment access and consent procedures as barriers to utilising recording as a method of feedback. The pandemic and RCA introduced online resources and imperative to utilise this method, resulting in largely positive GPST learning experiences. As we move away from the RCA it is important to retain institutional memory of the benefits gained from feedback using recorded methods.