Education for Primary Care最新文献

Introduction: COVID-19 presented major challenges to undergraduate GP placement capacity and there was an increased reliance on clinical training using facilitated simulation. The authors present a novel comparison of the effectiveness and cost-effectiveness of delivering a one-week primary care course using entirely GP-facilitated clinical teaching outside the GP setting against traditional practice-based GP clinical education.

Methods: A one-week GP placement was redeveloped from a traditional teaching model (TT-M) to an exclusively facilitated teaching model (FT-M) delivered outside the GP practice setting, using principles of blended learning, flipped classroom methods, e-learning and simulation. Both teaching models, delivered in different locations during 2022 to pre-clinical students, were evaluated using student feedback surveys for attainment of learning outcomes and course satisfaction.

Results: The students reported their consultation skills and clinical knowledge (amalgamated mean score 4.36 for FT-M versus 4.63 for TT-M; P = 0.05), as well as preparation for the clinical phases (mean scores 4.35 for FT-M versus 4.41 for TT-M; P = 0.68), were well developed and similar for both courses. Students reported similar enjoyment across both teaching models (FT-M mean score 4.31 versus 4.41 for TT-M; P = 0.49). The costs for delivering teaching per 4-h session for 100 students were £1,379 and £5,551 for FT-M and TT-M, respectively.

Conclusion: Delivery of a one-week primary care attachment to third year medical students using an FT-M was similarly effective and more cost effective than delivering it by a TT-M. FT-M potentially offers an important adjunct to clinical learning and resilience to capacity challenges for GP placements.

The Applied Knowledge Test (AKT) is one third of the licensing exam to become a General Practitioner in the United Kingdom. It is a computer-based, machine-marked multiple-choice examination with an overall pass rate of around 70%. Statistics reveal international medical graduates to have lower rates of passing. The aim of this evaluation was to determine the key features of preparation for the exam used by successful candidates. A questionnaire survey was sent to recently successful general practice trainees in Southampton. The results were further informed by a group interview and three in-depth interviews. A series of six areas were identified within the exam preparation that featured as common areas for all candidates. Further analysis showed the parameters around these areas suggesting the ability to maximise the candidates' chances of success. The areas included: preparation; time management; expectations; peer support; change of approach and impact on trainee mental health. A period of at least 10 hours per week for at least three months revision, using four to six resources and using question banks to consolidate learning rather than as a primary tool were found to be the key parameters with successful candidates. When to take the exam should be discussed with the trainer, the difficulty of the exam needs to be acknowledged by candidates, working in study groups can be beneficial and planning of the approach to revision was found to be essential. The impact of failure on trainee mental health must not be underestimated.

Purpose: As deaths from the illicit drug poisoning crisis continue to rise in Canada, increasing the number of healthcare professionals qualified to effectively prescribe opioids could be beneficial. The willingness of family medicine residents to undertake structured training in prescribing opioids for Opioid Agonist Treatment (OAT) and pain management have not been well described.

Materials and methods: Family medicine residents (n = 20) in British Columbia, Canada, were asked about their experience with and willingness to enrol in OAT training. Informed by the Consolidated Framework for Implementation Research, data were analysed thematically using NVivo software.

Results: Four themes were identified: (1) challenges to training implementation, (2) feelings and attitudes on prescribing practices, (3) helpful learning spaces and places of substance use training, and (4) recommendations for implementing training. Preparedness, exposure, and supportive learning environments for substance use education increased willingness to pursue OAT accreditation, while ineffective learning experiences, mixed feelings about opioid prescribing, and lack of protected time were the most common reasons for unwillingness.

Conclusions: Protected time and a range of clinical experiences appear to facilitate residents' willingness to complete OAT and opioid training. Implementation strategies to enhance the uptake of OAT accreditation in family medicine residency must be prioritised.

Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.

GP educationalists are crucial in training the future medical workforce and in developing and advancing the field of primary care medical education, yet opportunities in the UK are patchy and varied. In this article, a group of GP educationalists summarise the challenges facing the sustainability of this particular group of clinical academics and outline opportunities available at each career stage, from medical students through to senior GP educationalists. Recommendations to support the growth of this workforce include the development of a nationally recognised framework for GP educationalist careers, collaboration with professional and educational bodies and taking steps to level out opportunities in order to reduce existing inequity.

Exposing medical student cohorts to the lived reality of uncertainty and complexity experienced by GPs is challenging to achieve. We present a novel teaching concept: 'Challenge GP' designed for early years students. Gamification methodology is used to reproduce key elements of the 'duty GP' experience in a classroom setting where working in teams, students play a competitive card game. Cards drawn at random pose scenarios based on practical, logistical, and ethical dilemmas of a duty doctor surgery. Each team discusses whether to score by reporting a decision or play special cards to pass the dilemma onto, or collaborate with, another team. Answers are facilitated and scored by a GP tutor.Student feedback demonstrated highly effective learning for clinical reasoning, risk management and problem-solving. Students were exposed to the uncertainty and complexity of real-life medicine. Gamification, through competitiveness, increased task engagement. Students learned the value of working in teams under time pressure and grew in confidence by sharing knowledge in a safe environment. Students were enabled to think, feel and practise as real-life clinicians. This became a powerful force in contextualising their theory-based knowledge, aided understanding of the GP role and opened their eyes to a possible career in general practice.

Background: The Irish General Practitioner Training (GP) Programme is currently moving to Competency-Based Medical Education (CBME), facilitated by Programmatic Assessment (PA) and Entrustable Professional Activities (EPAs). These new assessment and feedback mechanisms may provide a rich and much sought-after dataset. However, given the possible number of feedback and assessment events, and the variety of modalities used, aggregating and interpreting these can be costly and difficult. Dashboard implementations (DI) have been purposed as a solution to bridge the gap between the large datasets and the training community at all levels.

Aims: To explore the Irish GP training community's perceptions on how an EPAs DI could facilitate the delivery of GP training in Ireland.

Methods: A qualitative approach was taken, using a focus group representative of different groups in the training community. Concurrently, an EPAs DI was developed. Focus group transcripts were analysed in an iterative fashion using Template Analysis to generate themes and subthemes.

Results: Numerous advantages were seen in relation to the implementation of an EPAs DI around entrustment decisions, constructive alignment and summative decision-making. These advantages, however, need to be tempered with the realisation that the EPAs DI is not and should not be misinterpreted as being the learning analytic panacea for GP training.

Conclusion: This paper outlines the perceptions from a postgraduate medical education training community on an EPAs DI, which would be applicable to other training communities considering introducing similar mechanisms.