Education for Primary Care最新文献

Background: In the UK, to encourage academic careers, extended education posts (EEPs) exist, where standard three-year, general practice vocational training is extended, offering trainees dedicated time to spend in another specialty such as medical education (Med Ed). Little is known about whether this impacts positively on their subsequent careers.

Aims: To explore general practitioners' (GPs') experiences and career trajectories after undertaking Med Ed EEPs.

Method: Twenty-eight GPs who completed a Med Ed EEP between 2013 and 2021 were invited to participate. Semi-structured interviews were held virtually. Transcripts were coded with NVivo software and underwent thematic analysis using Braun and Clarke's six-phase framework to ensure a reiterative process of internal validation.

Results: Eight GPs took part. All were working as NHS GPs, alongside other roles. Four themes emerged: 'growing as an academic educator', 'research can be interesting', 'the academic environment' and 'juggling multiple roles is stressful'. Most were still teaching, involved in research and had undertaken formal Med Ed training. Role models and immersion in academic teams were influential. Significant tensions and stresses were experienced when balancing multiple roles. The absence of ongoing academic training tracks contributed to this.

Conclusion: EEPs impact positively on academic career development and the acquisition of appropriate skills. However, managing multiple roles is challenging and stressful. Short-term university contracts, difficulties obtaining flexible working and resultant lack of partnership or salaried clinical work highlight an urgent need to explore fixed academic training pathways after vocational training, if sustainable recruitment into primary care academia is to be achieved.

The importance of involving patients in medical education is widely accepted, but their contribution to medical curriculum design is not well documented. Patients have the potential to bring a unique perspective and more refined experience to curriculum development. This applies particularly to those with long-term conditions (LTCs) who have multiple exposures to doctors throughout their healthcare journey. The aim of this study is to explore what views patients with LTCs have on the attributes medical students require to have, in order to provide them with high-quality care. Ten patients with LTCs, encompassing both primary and secondary care over a broad set of demographics, were interviewed by telephone using a semi-structured questionnaire. The interviews were recorded using a digital voice recorder and manually transcribed verbatim onto a Microsoft Word document for thematic analysis using NVIVO software and following Braun and Clarke's six-phase framework. Five themes have emerged highlighting where the care of LTC patients could be improved: 'advocacy'; 'compassion'; 'the desire to be acknowledged as an individual'"; acknowledgement of their expertise"; and 'benefits of continuity of care'. The findings make a major contribution to undergraduate and postgraduate clinical training development. They reinforce themes in healthcare which need more emphasis in the medical curriculum, whilst simultaneously highlighting that even well-recognised concepts such as patient-centred holistic care, are not well implemented in the context of actual practice.

Background: There is an established evidence base to support early clinical experience (ECE) within medical degree programmes. However, increasingly crowded clinical learning environments can make provision challenging. The aim of this research was to develop understanding about how ECE is provided within UK medical schools.

Methods: We conducted a cross-sectional study on ECE provision by UK medical schools using an electronic survey containing a mix of question styles. We gathered data on the stage at which ECE featured within curricula, the amount of ECE provided, the setting for ECE, the learning outcomes covered during ECE and whether such content was formally assessed. Support for survey dissemination was obtained from the UK Medical Schools Council (MSC) Education Leads Advisory Group (ELAG). Responses were collected between 10/05/23 and 11/10/23.

Findings: Of the 43 eligible UK medical schools, responses were received from 28 (65%). The provision of ECE amongst respondent medical schools was ubiquitous. The majority of ECE was provided within general practice and hospital settings, but community and voluntary sector settings were increasingly employed, as was technology enhanced ECE. A significant shift in the nature of the content addressed during ECE, with less focus on implementation of basic science was seen within learning outcomes. The extent to which ECE learning outcomes were formally assessed was variable.

Conclusion: The amount of ECE provided by UK medical schools has fallen. We encourage institutions to reflect on their provision of ECE and to consider how greater diversity of community settings and technology-enhanced learning could be harnessed.

Background: Introducing medical students to the concept of Cultural Humility, we devised a teaching initiative for students to consider how power manifests through the use of language in clinical communication, with a focus on General Practice. Cultural Humility is a pedagogical framework, introduced by Tervalon and Murray-Garcia, to address what they consider as the limitations of the Cultural Competence model.

Approach: Our teaching initiative specifically focused on power in clinical communication, both oral consultations and written notes. The session was delivered to third-year medical students during their first 'clinical' year, where they regularly witness and are involved in clinical communication across primary and secondary care placements. Ethical approval was in place to analyse students' reflections on the session.

Evaluation: Students who attended engaged well. They evaluated the session positively as increasing their awareness of the power of clinical language in negatively stereotyping and dehumanising patients. They demonstrated Cultural Humility in their reflections of the unintentional harm of clinical language commonly used for the doctor-patient relationship. However, most striking for us, and where our learning as educators lies, was the low attendance at the session, despite our attempts to underline clinical relevance and importance for development as future doctors.

Implications: This article offers a framework for educators interested in Cultural Humility. The implications of this initiative are how (or how not) to develop and deliver training in this space. More consideration is required as educators, including around our own language, as to how to engage students to think around the complex topic of power.

Reflective practice is fundamental to postgraduate general practitioner (GP) training and ongoing professional development. However, real-world challenges like time constraints and professional isolation often limit meaningful engagement with this critical skill. This article proposes that large language models (LLMs), sophisticated artificial intelligence systems, may have potential for enhancing reflective practice. We present three case studies, in which we explore the ability of LLMs to generate thought-provoking questions, which could prompt GPs to consider new angles, address underlying factors, and bridge the gap between theory and practice. Our findings suggest that LLMs could help reframe experiences and foster deeper self reflection, particularly for isolated practitioners. While ethical concerns regarding privacy, over reliance, and potential biases exist, we consider the possibility of responsibly integrating LLMs into reflective practice. For trainees, AI-generated questions might complement personal reflection under guidance. For GPs working in isolation, LLMs present an opportunity to enhance reflective practice, challenging us to consider a place for this technological innovation without diminishing the human aspects essential to medical practice.

We present a model for delivering out-of-hours (OOH) teaching to year 3 medical students at Glasgow University. Clinical placement time in general practice for students is under unprecedented pressure, and scope to further increase placement capacity in daytime general practice is challenging. The OOH primary care setting is underutilized in Glasgow. We undertook a four-week pilot study based in two OOH centres in Glasgow. Third year medical students could sign up to attend a three-hour teaching session at an OOH site with a dedicated GP tutor. The logistical arrangements and evaluation of this pilot project are presented. Student, GP tutor, OOH staff and administration staff logistics are considered and learning opportunities for students in this setting are discussed. The pilot study received positive feedback from all stakeholders. Our project provides a model for further teaching in this environment to help mitigate placement shortage and provide additional valuable general practice clinical experience for students. The capacity for teaching in the OOH setting could be easily upscaled by either increasing the duration of the placement or utilising more out-of-hours sites for teaching.

The use of point-of-care ultrasonography in primary care is increasing. Primary care physicians are introduced to ultrasonography at short workshops with little guidance for implementation of the technology in clinical routines and medical decision-making. This article introduces a framework for longitudinal ultrasound education tailored for office-based general practice, building on the best available evidence and established teaching principles. The framework includes three teaching seminars over three months, a curriculum of 10 ultrasound applications, an online learning platform providing educational support before, during, and after the teaching seminars and continuous support and feedback from allocated mentors. The framework aims to reduce primary care physicians' absence from the clinic, scaffold the learning process to build a solid and sustainable foundation of knowledge, and support implementation and appropriate use of the technology in the unselected patient population in primary care setting. Evaluation of the framework demonstrated high satisfaction with the educational elements among both participants and teachers.