Education for Primary Care最新文献

General Practice has changed over the past decade. Expansion of clinicians' roles may create uncertainty, stress, and overload - particular for those at the start of their career. The WONCA Europe network for medical education, EURACT, has published competency-based aims and requirements for speciality training in general practice. Greater understanding of the trainee perspective would support planning and delivery of postgraduate training curricula. This two-step study aims to provide a competency priority list, created by European early career general practitioners, to highlight skills that this generation considers highly essential in future speciality training. A competency list was drafted with trainee- and early career general practitioners from across Europe at the Vasco da Gama Movement Forum (Edinburgh, January 2022). Participants identified competencies that they regarded as most relevant for future speciality training in their respective national contexts. Competencies were coded into categories and ranked in two consecutive rounds, the first taking place online and the second at WONCA Europe (London, June 2022). After two rounds, a consensual list of three main competencies for each category was drafted. The top three competencies for each category remained the same throughout both rounds and may be considered competencies that early career general practitioners in Europe consider important for training. Prioritisation of these competencies by institutions and educators within general practice training programmes may support trainees' satisfaction and perceived preparedness for practice.

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students' clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings' significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.

In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs).Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it.For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%).This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time.The key message is that differential attainment should not be in the 'too hard basket'. The narrative is changing from 'can't do' to 'must do', supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.

As 3rd-year medical students at Imperial College London, we investigated Salbutamol overuse in the community of Islington. We were inspired to carry out this project due to the high prevalence of Salbutamol overuse which became evident during our GP placement. This was part of our Community Action Project (CAP) which aims for students to investigate issues within their GP practice and patient population and create solutions to help overcome this, like a quality improvement project. This project focused on the local community around the GP practice. We spoke to 11 patients individually who were at high risk of severe asthma attacks, assessing their understanding of Salbutamol and their Salbutamol usage. Patients had varied responses, with some using their inhaler five times a day, to others using it very rarely. This project gave us newly found insight into the growing issue of Salbutamol overuse. Using the information gathered from these patient interviews, we produced an educational poster about Salbutamol inhaler usage.

Introduction: Effective communication is essential for patient-centred relationships. Although medical graduates acquire communication skills during undergraduate training, these have been shown to be inadequate in early practice. Both students' and patients' perspectives are required to improve readiness for the workplace, patient satisfaction, and health outcomes. Our research question was: to what extent are medical students prepared with patient-centred communication skills in primary care settings?

Methods: A qualitative descriptive research study using in-depth semi-structured interviews was conducted with Year 3 medical students and patients to study their experiences at a primary care clinic, over two weeks. Data were transcribed verbatim and analysed using Braun and Clark's thematic analysis. Both students' and patients' views on communication skills were obtained.

Results: Three themes were established based on student-patient communication in primary care settings: socio-cultural elements in student-patient communication; cognitive and emotional challenges for effective communication; and enablers for effective student-patient communication. The themes and sub-themes describe both students and patients valuing each other as individuals with socio-cultural beliefs and needs.

Conclusion: The findings can be used to structure new approaches to communication skills education that is patient-centred, culturally sensitive, and informed by patients. Communication skills training should encourage students to prioritise and reflect more on patient perspectives while educators should engage patients to inform and assess the outcomes.

The UK general practice model has been described as the 'jewel in the crown' of the National Health Service and is widely respected and emulated around the world. In recent years, there has been a particular interest in the UK approach to primary care medical education, including at undergraduate and postgraduate levels, leading to a number of international education partnerships designed to draw on the best of UK experience and expertise in this area. Drawing on the limited academic literature in this area, and the authors' personal experiences of working across many international partnership projects with countries around the world, this article reflects on the central importance of respect and reflexivity when engaging in such work. A respectful approach relies on a genuine and deep curiosity for the local context, and a desire to empower partners to build their own solutions that are contextually authentic. A reflexive approach, meanwhile, relies on those engaging in partnerships to understand themselves as 'invited guests' and to remain mindful of current and historical power differentials and inequities when framing their engagement, looking both inwardly and outwardly as they conduct themselves. As primary care education around the world develops and expands, there may be a greater role for international partnerships and it is critically important that those engaging in such partnerships bring a thoughtful and scholarly lens to this work.

Background: Clinical placements for medical students in the United Kingdom (UK) came to an abrupt halt in March 2020. The rapidly evolving Covid19 pandemic created specific challenges for educators, balancing safety concerns for patients, students and healthcare staff alongside the imperative to continue to train future clinicians. Organisations such as the Medical Schools Council (MSC) published guidance to help plan return of students to clinical placements. This study aimed to examine how GP education leads made decisions around students returning to clinical placements for the 20/21 academic year.

Method: Data collection and analysis was informed by an Institutional Ethnographic approach. Five GP education leads from medical schools throughout the UK were interviewed (over MS TEAMS™). Interviews focused on the work the participants did to plan students' return to clinical placements and how they used texts to inform this work. Analysis focused on the interplay between the interview and textual data.

Results and discussion: GP education leads actively used MSC guidance which confirmed students to be 'essential workers', an unquestioned and unquestionable phrase at the time. This permitted students to return to clinical placements by affording the GP education leads authority to ask or persuade GP tutors to accept them. Furthermore, by describing teaching as 'essential work' in its own right in the guidance, this extended what the GP tutors came to expect to do as 'essential workers' themselves.

Conclusion: GP education leads activated authoritarian phrases such as 'essential workers' and 'essential work' contained within MSC guidance to direct students' return to clinical placements in GP settings.