Education for Primary Care最新文献

{"title":"Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education.","authors":"Nur Faraheen Abdul Rahman, Nathan Davies, Julia Suhaimi, Faridah Idris, Sharifah Najwa Syed Mohamad, Sophie Park","doi":"10.1080/14739879.2023.2248070","DOIUrl":"10.1080/14739879.2023.2248070","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":" ","pages":"211-219"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41154756","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":"Tackling differential attainment in specialist GP training in England and Scotland.","authors":"Debra de Silva, Rachel Roberts, Vijay Nayar, Graham Rutt, Simon Gregory, Amjad Khan","doi":"10.1080/14739879.2023.2243453","DOIUrl":"10.1080/14739879.2023.2243453","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":" ","pages":"199-203"},"PeriodicalIF":1.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109920","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 reflection on Salbutamol overuse in one GP practice in Islington: a community action project at Imperial College London.","authors":"Adele Schiff, Rayan Kamal","doi":"10.1080/14739879.2023.2241040","DOIUrl":"10.1080/14739879.2023.2241040","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":" ","pages":"233-236"},"PeriodicalIF":1.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10140601","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":"Communication skills in primary care settings: aligning student and patient voices.","authors":"Chandramani Thuraisingham,&nbsp;Siti Suriani Abd Razak,&nbsp;Vishna Devi Nadarajah,&nbsp;Norul Hidayah Mamat","doi":"10.1080/14739879.2023.2210097","DOIUrl":"https://doi.org/10.1080/14739879.2023.2210097","url":null,"abstract":"<p><strong>Introduction: </strong>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?</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"123-130"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9914823","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 art of writing letters to journals….","authors":"Simon Gay","doi":"10.1080/14739879.2023.2215209","DOIUrl":"https://doi.org/10.1080/14739879.2023.2215209","url":null,"abstract":"","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"111"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861613","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":"Respect and reflexivity: international education partnerships in primary care.","authors":"Mohammed Ahmed Rashid,&nbsp;Anwar Ali Khan","doi":"10.1080/14739879.2023.2178332","DOIUrl":"https://doi.org/10.1080/14739879.2023.2178332","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"119-122"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9914321","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":"Golden triangle of opportunity.","authors":"Linzi Lumsden","doi":"10.1080/14739879.2023.2204298","DOIUrl":"https://doi.org/10.1080/14739879.2023.2204298","url":null,"abstract":"","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"175"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9914809","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":"Essential workers? An institutional ethnographic lens on pandemic GP placements.","authors":"Grainne P Kearney,&nbsp;Helen Reid,&nbsp;Nigel D Hart","doi":"10.1080/14739879.2023.2182715","DOIUrl":"https://doi.org/10.1080/14739879.2023.2182715","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results and discussion: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"131-137"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10236928","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":"Comparison of the effectiveness of exclusively facilitated clinical teaching as an alternative to traditional practice-based primary care placements.","authors":"Edward G Tyrrell,&nbsp;Richard Knox,&nbsp;Runa Saha,&nbsp;Kathryn Berry,&nbsp;Jaspal S Taggar","doi":"10.1080/14739879.2023.2217795","DOIUrl":"10.1080/14739879.2023.2217795","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The students reported their consultation skills and clinical knowledge (amalgamated mean score 4.36 for FT-M versus 4.63 for TT-M; <i>P</i> = 0.05), as well as preparation for the clinical phases (mean scores 4.35 for FT-M versus 4.41 for TT-M; <i>P</i> = 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; <i>P</i> = 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"152-160"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237989","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 benefits of the expansion of the social prescribing student champion scheme into allied health professionals.","authors":"A de Iongh,&nbsp;D Kirtley","doi":"10.1080/14739879.2023.2204307","DOIUrl":"https://doi.org/10.1080/14739879.2023.2204307","url":null,"abstract":"Dear Editor, In 2020, a Twitter debate initiated the inclusion of allied healthcare professionals (AHPs) within the wellestablished Social Prescribing Student Champion Scheme [1]. The scheme gave medical students the opportunity to champion social prescribing (SP) by delivering peer-teaching [2]. Since the scheme was founded in 2017, the importance of SP has grown, with the potential contribution of AHPs further highlighted [3,4]. Therefore, the scheme expanded to include AHPs. Our role as leads for the medical and AHP branches of the scheme was to work together to develop a structure that met our different learning needs while successfully integrating the two branches of the scheme. This required more than a tokenistic insertion of 'and other healthcare professional students' into the scheme text. To truly integrate both ‘branches’ of the scheme, when we all have different professional applications of social prescribing, we needed to recognise what we all had in common as students – the shared purpose of making a positive difference for our patients. Although as students, we spend time developing our own professional identities, it was refreshing to remember ‘we have more in common than divides us’. Students were able to unite over this, and the new AHP champions were welcomed and integrated into the scheme by medical students. It was also helpful to recognise that under the umbrella of one profession, such as medicine, or professional cohort such as AHP, there remains enormous variation in roles and interests – a valuable lesson for future MDT working. As is common within MDT working, organising meetings was difficult, but working through the pandemic normalised virtual platforms and collaborative software. It also helped us to develop insights into the pressures and demands we all have during training, fostering respect for the time and effort spent developing our respective professional skills. One challenge was that our core team was not representative of all fourteen AHPs. However, conversations with respective professional bodies enabled the scheme to gain authenticity which facilitated approaching universities about the scheme, and furthered our MDT learning. The scheme’s structure did not directly incorporate the voluntary sector, which forms the backbone of social prescribing, and this provided a valuable lesson in the wider scope for collaboration beyond organisational boundaries, as is routinely required within clinical practice. Both branches had very different journeys in their inception, so while treating and evaluating the scheme as a whole, we also wanted to recognise the established track record of the medical scheme, and manage expectations of delivery of the AHP scheme in the first year. Therefore, collaboration rather than direct comparison was important. We are able to recognise each others’ relative successes and the cumulative impact of these for the scheme as a whole, which was more than the sum of its parts. Having since","PeriodicalId":46436,"journal":{"name":"Education for Primary Care","volume":"34 3","pages":"176-177"},"PeriodicalIF":1.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9861059","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}