BJGP Open最新文献

{"title":"Incidence and management of Lyme disease: a Scottish general practice retrospective study.","authors":"Sally Mavin, Swapna Guntupalli, Michael Robb","doi":"10.3399/BJGPO.2023.0241","DOIUrl":"10.3399/BJGPO.2023.0241","url":null,"abstract":"<p><strong>Background: </strong>The true burden of Lyme disease in primary care in Scotland is unknown. Epidemiological data are currently based on laboratory-confirmed reports as there is no mandatory reporting of clinical cases.</p><p><strong>Aim: </strong>To analyse data from general practice in NHS Highland (North) over a 6-year period to assess the incidence and management of Lyme disease in primary care.</p><p><strong>Design & setting: </strong>This was a retrospective descriptive study. Study data from 2017 to 2022 were extracted from all 63 general practices within NHS Highland (North).</p><p><strong>Method: </strong>Consultations for Lyme disease were identified via Lyme-related clinical Read codes, requests for borrelia tests , free text, 'tags' and/or Lyme disease antibiotic scripts.</p><p><strong>Results: </strong>Using Read codes to identify patients with Lyme disease or suspected Lyme disease gave an estimated average annual incidence of 124/100 000 population, which was 2.1 times more than estimates based solely on laboratory-confirmed reports. The incidence figures increased 5.2 times (362/100 000 population) when patients with Lyme disease or suspected Lyme disease (identified via Read codes, laboratory test requests, and free text tags) who were given antibiotic treatment were taken into account. Local 'hot spots' of infection were identified. Analysis of the antibiotic data indicates that antibiotic prescribing in NHS Highland largely follows the National Institute for Health and Care Excellence (NICE) guidelines.</p><p><strong>Conclusion: </strong>This data analysis pathway can, and should, be rolled out across the whole of Scotland to assess the incidence and management of Lyme disease in primary care and allow appropriate allocation of resources.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-guided deep vein thrombosis diagnosis in primary care: protocol for cohort with qualitative assessment.","authors":"Kerstin Nothnagel, Alastair Hay, Jessica Watson, Jonathan Banks","doi":"10.3399/BJGPO.2024.0165","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0165","url":null,"abstract":"<p><strong>Background: </strong>Deep vein thrombosis (DVT), a formation of blood clots within deep veins, mostly of the proximal lower limb, has an annual incidence of 1-2 per 1,000. Patients who are affected by multiple chronic health conditions and who experience limited mobility are at high risk of developing DVT.Traditional DVT diagnosis involves probabilistic assessment in primary care, followed by specialised ultrasound scans (USS), mainly conducted in hospitals. The emergence of point-of-care ultrasound (POCUS), coupled with artificial intelligence (AI)-applications has the potential to expand primary care diagnostic capabilities.</p><p><strong>Aim: </strong>To assess the accuracy and acceptability of AI-guided POCUS for DVT diagnosis when performed by non-specialists in primary care.</p><p><strong>Design & setting: </strong>Diagnostic cross-sectional study coupled with a qualitative evaluation conducted at primary care DVT clinics.</p><p><strong>Method: </strong>First, a diagnostic test accuracy (DTA) study will investigate the accuracy of AI-guided POCUS in 500 individuals with suspected DVT, performed by healthcare assistants (HCAs). The reference standard is the standard of care USS conducted by sonographers. Second, after receiving both scans, participants will be invited to complete a patient satisfaction survey (PSS). Finally, semi-structured interviews with 20 participants and 5 HCAs will explore the acceptability of AI-guided POCUS DVT diagnosis.</p><p><strong>Conclusion: </strong>This study will rigorously evaluate the accuracy and acceptability of AI-guided POCUS DVT diagnosis conducted by non-specialists in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease - alternative labels used by Australian general practitioners. A qualitative interview study.","authors":"Michelle Guppy, Esther Joy Bowles, Paul Glasziou, Jenny Doust","doi":"10.3399/BJGPO.2024.0031","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0031","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for terminology defining chronic kidney disease (CKD) have been in use for 20 years. Age is not currently considered in the guideline definition of CKD. In previous studies, General Practitioners (GPs) have been reluctant to give older patients the label of CKD.</p><p><strong>Aim: </strong>Our study aimed to determine what language general practitioners are using to describe or label chronic kidney disease with their older patients, and to explore the reasons for their use of alternative language.</p><p><strong>Design & setting: </strong>This was a descriptive qualitative interview study of Australian GPs.</p><p><strong>Method: </strong>Twenty-seven GPs were recruited via email and interviewed regarding their management of CKD., GPs were asked what language and terminology they used when discussing a diagnosis of CKD with their older patients.</p><p><strong>Results: </strong>\"Labelling of CKD\", the language that GPs use when talking about CKD with their patients, emerged as a major theme from the initial GP interviews. Sub-themes emerged, including: types of labels, alternate labels and rationale for alternate labelling. GPs used descriptions of \"reduced kidney function\" to explain CKD to their patients, either in parallel with the diagnosis of CKD or instead of it. GPs had concerns about the words \"chronic\" and \"disease\" and used different terminology to explain these words to patients when diagnosing them with CKD.</p><p><strong>Conclusion: </strong>GPs use alternative descriptions to explain mild decrease in kidney function with older patients. Alternative labels that denote level of risk to older patients, without creating unnecessary concern about normal age-related kidney function need to be explored.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of unexpected weight loss and cancer: risk, guidelines, and recommendations for follow-up in primary care.","authors":"Javiera Martinez-Gutierrez, Lucas De Mendonca, Philip Ly, Alex Lee, Barbara Hunter, Jo-Anne Manski-Nankervis, Sophie Chima, Deborah Daly, George Fishman, Fong Seng Lim, Benny Wang, Craig Nelson, Brian Nicholson, Jon Emery","doi":"10.3399/BJGPO.2024.0025","DOIUrl":"10.3399/BJGPO.2024.0025","url":null,"abstract":"<p><strong>Background: </strong>Cancer diagnoses often begin with consultations with general practitioners (GPs), but the nonspecific nature of symptoms can lead to delayed diagnosis. Unexpected weight loss (UWL) is a common nonspecific symptom linked to undiagnosed cancer, yet guidelines for its diagnostic assessment in general practice lack consistency.</p><p><strong>Aim: </strong>To synthesise evidence on the association between UWL and cancer diagnosis, and to review clinical guidelines and recommendations for assessing patients with UWL.</p><p><strong>Design and settings: </strong>Systematic search and analysis of studies conducted in primary care.</p><p><strong>Method: </strong>Four databases searched for peer-reviewed literature from 2012 to 2023. Two reviewers conducted all the steps. A narrative review was conducted detailing the evidence for UWL as a risk factor for undiagnosed cancer, existing clinical guidance, and recommended diagnostic approach.</p><p><strong>Results: </strong>We included 25 studies involving 916,092 patients; 92% provided strong evidence of an association between UWL and undiagnosed cancer. The National Institute for Health Care and Excellence Cancer Guideline in the UK was frequently cited. General suggestions encompassed regular weight monitoring, family history, risk factor evaluation, additional signs and symptoms, and a comprehensive physical examination. Commonly recommended pathology tests included C-reactive protein, complete blood count, alkaline phosphatase, and thyroid-stimulating hormone. Immunochemical faecal occult blood test, abdominal ultrasound, and chest X-ray were also prevalent. One large cohort study provided age, sex, and differential diagnosis-specific recommendations.</p><p><strong>Conclusion: </strong>This evidence review informs recommendations for investigating patients with UWL and will contribute to a computer decision support tool implementation in primary care, enhancing UWL assessment and potentially facilitating earlier cancer diagnosis.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving discharge summaries from hospital with a brief recommendation text box - results from a nationwide survey.","authors":"Thorbjørn H Mikkelsen, Jesper B Nielsen, Maria M Storsveen, Jens Søndergaard","doi":"10.3399/BJGPO.2024.0046","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0046","url":null,"abstract":"<p><strong>Background: </strong>Danish hospital physicians are obliged to mark the discharge summaries addressing whether the patient's GP is recommended to follow up, as well as to state suggested follow-up actions in a recommendation text box.</p><p><strong>Aim: </strong>This study aims to investigate the GP's experiences with the recommendation text box.</p><p><strong>Design & setting: </strong>A questionnaire sent to a representative sample of general practitioners in Denmark.</p><p><strong>Method: </strong>A questionnaire was prepared for GPs based on background material, focus group interviews and discussions with GPs and hospital physicians. It was subsequently pilot-tested by fellow researchers and GPs and revised prior to the survey.</p><p><strong>Results: </strong>Almost ¾ of the general practitioners (72%) 'totally or partly agree' that the recommendation text box is easy to find. In addition, our results show significant differences between software used by the GPs. Almost 2/3 (63%) 'totally agree' or 'partly agree' that the recommendation text box provides brief and precise information about the recommended follow-up.</p><p><strong>Conclusion: </strong>GPs generally find that the recommendation text box provides them with brief and precise information about the recommended follow-up. In addition, the software used by the GPs has a significant influence on how the recommendation text box is presented.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathways to MPN presentation and time-to-diagnosis: results from a cross-sectional study.","authors":"Emma-Louise Tarburn, Lisa Iversen, Charlotte Robertson, Charlene McShane, Andrew Duncombe, Mary-Frances McMullin, Claire Harrison, Ruben Mesa, Lesley A Anderson","doi":"10.3399/BJGPO.2024.0068","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0068","url":null,"abstract":"<p><strong>Background: </strong>Early cancer recognition is key to improving patient outcomes. Diagnosis is often delayed in myeloproliferative neoplasm (MPN) patients, putting them at risk of thromboembolic events and other complications pre-diagnosis. A clear understanding of the barriers to presentation and diagnosis is required.</p><p><strong>Aims: </strong>To explore barriers and factors influencing delayed presentation and diagnosis of MPNs.</p><p><strong>Design & setting: </strong>A cross-sectional study of MPN patients within the United Kingdom and the Republic of Ireland.</p><p><strong>Method: </strong>An online cross-sectional survey of MPN patients. Symptoms and factors influencing patient and General Practitioner (GP) delay were examined. Adjusted odds ratios (aOR) were calculated to explore the relationship between these factors and patient/GP delay.</p><p><strong>Results: </strong>Most (80.2%) of the 620 patients completing the survey reported symptomatic presentation. The most common symptoms associated with patient delay were pruritus (aOR 1.89, 95% CI 1.19-3.01), headaches (aOR 1.86, 95% CI 1.13-2.82) and concentration difficulties (aOR 1.75, 95% CI 1.12-2.76). Attributing symptoms to ageing (aOR 1.92, 95% CI 1.19-3.11) and not wanting to burden the GP (aOR 2.17<b>,</b> 95% CI 1.35-3.50) were significantly associated with patient delay. Those reporting >3 blood cancer warning signs were more likely to experience GP delay than those experiencing fewer (aOR 3.26<b>,</b> 95% CI 1.75-6.29), and lack of relational continuity of GP care was significantly associated with GP delay (aOR 3.41, 95% CI 1.65-7.28).</p><p><strong>Conclusion: </strong>Debunking misconceptions around ageing, encouraging timely communication with GPs and improving relational continuity of GP care could assist in reducing diagnostic delays, prevent potentially fatal disease complications and ultimately improve MPN patient outcomes.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The under-representation of racially minoritised doctors in academic general practice training: a retrospective analysis.","authors":"Alice Howe, Chloe Orkin, Vanessa Apea","doi":"10.3399/BJGPO.2023.0136","DOIUrl":"10.3399/BJGPO.2023.0136","url":null,"abstract":"<p><strong>Background: </strong>General practice has one of the most diverse medical training programmes in terms of sex and ethnic background. However, this diversity of race and ethnicity is not reflected in academic GP careers, with just 17% (<i>n</i> = 81/473) of academic GPs being from racially minoritised groups, according to the Medical Schools Council.</p><p><strong>Aim: </strong>To determine whether GP academic clinical fellow (ACF) trainees from racially minoritised backgrounds are proportionally represented, compared with the non-academic training programme, using the annual GP ACF conference as a proxy.</p><p><strong>Design & setting: </strong>A retrospective analysis of conference programmes from national academic GP training conferences from 2018-2023 and demographic data obtained from Health Education England (HEE).</p><p><strong>Method: </strong>Using conference programmes and online searches, demographic information on conference speakers was obtained and a freedom of information request was made to HEE for the demographics of GP ACFs for corresponding years. This was compared with demographic data of GP trainees and academics.</p><p><strong>Results: </strong>On average, there were 40 speakers each year at the conference. White females (average 20.2 speakers each year) were the most well represented group, followed by White males (average 12.5), Asian females (average 3.3), Asian males (average 1.8), Black males (average 0.7), and Black females (average 0.3). HEE data from 2022 revealed that 27 (71.1%) of the 38 (excluding five who did not state their ethnicity) ACFs were White British.</p><p><strong>Conclusion: </strong>GP academia should be more representative of the non-academic GP training scheme. Work needs to be done to understand and overcome the structural barriers to recruiting from racially minoritised groups.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of remote consultation on general practitioners' antibiotic prescriptions in 2021: a French observational study.","authors":"Cécile Rullier, Vincent Tarazona, David De Bandt","doi":"10.3399/BJGPO.2023.0196","DOIUrl":"10.3399/BJGPO.2023.0196","url":null,"abstract":"<p><strong>Background: </strong>In patients with infectious diseases, remote consultation (RC) may be questionable compared with face-to-face office consultation (OC), not only because of the lack of physical examination but also because of the risk of overprescribing antibiotics (ATBs).</p><p><strong>Aim: </strong>To analyse ATB prescription in OC versus RC in a sample of French GPs.</p><p><strong>Design & setting: </strong>This is a retrospective observational cohort study in general practice in 2021. Anonymised data were collected from voluntary GPs.</p><p><strong>Method: </strong>The influence of the mode of consultation on ATB prescription was analysed using a χ² test. A secondary multivariate analysis investigated the factors influencing the use of OC or RC in patients who received at least one ATB.</p><p><strong>Results: </strong>In total, 35 503 consultations with an identifiable rating were included, corresponding to seven doctors' activities, practising with five locums and three residents. ATBs were prescribed in 10.41% of RCs and 6.77% of OCs (<i>P</i><0.01). RC was associated with more frequent prescription of ATBs for respiratory and ear, nose, and throat (ENT) viral infections and urinary tract infections. For patients aged 20-40 years, ATB prescription was more associated with RC.</p><p><strong>Conclusion: </strong>RC is associated with a more frequent ATB prescription than OC, mostly for patients aged 20-40 years, who are most likely to use new technologies; and for urinary tract infections or respiratory and ENT viral infections. Further studies on RC outcomes should be conducted to better analyse the impact of RC on the prescribing of ATBs.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of treatment outcomes. Patients with persistent physical symptoms in primary care.","authors":"Cathrine Abrahamsen, Knut Reidar Wangen, Morten Lindbaek, Erik Lønnmark Werner","doi":"10.3399/BJGPO.2024.0004","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0004","url":null,"abstract":"<p><strong>Background: </strong>Persistent physical symptoms (PSS) are consistently prevalent among primary care patients. PSS can negatively affect quality of life, healthcare costs, and work participation.</p><p><strong>Aim: </strong>To examine predictors of treatment outcome in patients with who received treatment by a work-focused communication tool known as the Individual Challenge Inventory Tool (ICIT) delivered by the patient's general practitioner. In a previous study we found substantially improved outcomes and reduced sick leave for patients treated by the work-focused communication tool ICIT compared to a control group.</p><p><strong>Design & setting: </strong>This study is based on the findings of our previous cluster randomised controlled trial.</p><p><strong>Method: </strong>Regression analyses of the intervention group were used to identify predictors (all measured at baseline) of improvements in Patient Global Impression of Change (PGIC) and sick leave after 11 weeks follow up.</p><p><strong>Results: </strong>Living alone predicted improvement in the adjusted model (OR =4·03, 95% CI: 1·33-12·25, <i>P</i>=0·014). Receiving long term benefits predicted improved PGIC in both the unadjusted (OR =2·30, 95% CI: 1·21-4·39, <i>P</i>=0·011) and adjusted models (OR =2·46, 95% CI: 1·04-5·83, <i>P</i>=0·040). In addition, living alone predicted reduced sick leave in the adjusted model (OR =3·23, 95% CI: 1·11-9·42, <i>P</i>=0·032.</p><p><strong>Conclusion: </strong>In general, there were few factors to predict the outcome of the work-focused communication tool ICIT. We therefore suggest that this work-focused communication tool ICIT is applicable to most patients with PPS. GPs may consider using the ICIT for all primary care patients who exhibit ineffective coping strategies in their daily lives and work, especially those who live alone.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning to navigate uncertainty in primary care: a scoping literature review.","authors":"Nick P Gardner, Gerard J Gormley, Grainne P Kearney","doi":"10.3399/BJGPO.2023.0191","DOIUrl":"10.3399/BJGPO.2023.0191","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice occurs in the context of uncertainty. Primary care is a clinical environment that accepts and works with uncertainty differently from secondary care. Recent literature reviews have contributed to understanding how clinical uncertainty is taught in educational settings and navigated in secondary care, and, to a lesser extent, by experienced GPs. We do not know how medical students and doctors in training learn to navigate uncertainty in primary care.</p><p><strong>Aim: </strong>To explore what is known about primary care as an opportunity for learning to navigate uncertainty.</p><p><strong>Design & setting: </strong>Scoping review of articles written in English.</p><p><strong>Method: </strong>Using a scoping review methodology, Embase, MEDLINE, and Web of Science databases were searched, with additional articles obtained through citation searching. Studies were included in this review if they: (a) were based within populations of medical students and/or doctors in training; and (b) considered clinical uncertainty or ambiguity in primary care or a simulated primary care setting. Study findings were analysed thematically.</p><p><strong>Results: </strong>Thirty-six studies were included from which the following three major themes were developed: uncertainty contributes to professional identity formation (PIF); adaptive responses; and maladaptive behaviours. Relational and social factors that influence PIF were identified. Adaptive responses included adjusting epistemic expectations and shared decision making (SDM).</p><p><strong>Conclusion: </strong>Educators can play a key role in helping learners navigate uncertainty through socialisation, discussing primary care epistemology, recognising maladaptive behaviours, and fostering a culture of constructive responses to uncertainty.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}